Interhospital transfers of the critically ill: Time spent at referring institutions influences survival.
OBJECTIVE
To determine if the length of stay at a referring institution intensive care unit (ICU) before transfer to a tertiary/quaternary care facility is a risk factor for mortality.


DESIGN
We performed a retrospective chart review of patients transferred to our ICU from referring institution ICUs over a 3-year period. Logistical regression analysis was performed to determine which factors were independently associated with increased mortality. The primary outcomes were ICU and hospital mortality.


MAIN RESULTS
A total of 1248 patients were included in our study. Length of stay at the referring institution was an independent risk factor for both ICU and hospital mortality (P<.0001), with increasing lengths of stay correlating with increased mortality. Each additional day at the referring institution was associated with a 1.04 increase in likelihood of ICU mortality (95% confidence interval, 1.02-1.06; P =0.001) and a 1.029 (95% confidence interval, 1.01-1.05; P .005) increase in likelihood of hospital mortality.


CONCLUSIONS
Length of stay at the referring institution before transfer is a risk factor for worse outcomes, with longer stays associated with increased likelihood of mortality. Further studies delineating which factors most affect length of stay at referring institutions, though a difficult task, should be pursued.
['Hanane|Tarik|T|', 'Wiles|Samuel|S|', 'Senussi|Mourad H|MH|', 'Han|Xiaozhen|X|', 'Wang|Xiao-Feng|XF|', 'Hite|R Duncan|RD|', 'Guzman|Jorge A|JA|']
D018806:APACHE D016638:Critical Illness D005260:Female D017052:Hospital Mortality D006801:Humans D007362:Intensive Care Units D007902:Length of Stay D008297:Male D008875:Middle Aged D009820:Ohio D017063:Outcome Assessment, Health Care D010360:Patient Transfer D012017:Referral and Consultation D012044:Regression Analysis D012189:Retrospective Studies D012307:Risk Factors
Interhospital transfer