دورية أكاديمية
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The Impact of Timing on Clinical and Economic Outcomes During Inter-ICU Transfer of Acute Respiratory Failure Patients: Time and Tide Wait for No One.

التفاصيل البيبلوغرافية
العنوان: The Impact of Timing on Clinical and Economic Outcomes During Inter-ICU Transfer of Acute Respiratory Failure Patients: Time and Tide Wait for No One.
المؤلفون: Nadig NR; Department of Medicine, Division of Pulmonary, Critical Care Medicine and Sleep, Northwestern University Feinberg School of Medicine, Chicago, IL., Brinton DL; Department of Healthcare Leadership and Management, Medical University of South Carolina, Charleston, SC., Simpson KN; Department of Healthcare Leadership and Management, Medical University of South Carolina, Charleston, SC., Goodwin AJ; Department of Medicine, Division of Pulmonary, Critical Care Medicine and Sleep, Medical University of South Carolina, Charleston, SC., Simpson AN; Department of Healthcare Leadership and Management, Medical University of South Carolina, Charleston, SC., Ford DW; Department of Medicine, Division of Pulmonary, Critical Care Medicine and Sleep, Medical University of South Carolina, Charleston, SC.
المصدر: Critical care explorations [Crit Care Explor] 2022 Mar 01; Vol. 4 (3), pp. e0642. Date of Electronic Publication: 2022 Mar 01 (Print Publication: 2022).
نوع المنشور: Journal Article
اللغة: English
بيانات الدورية: Publisher: Wolters Kluwer Health Country of Publication: United States NLM ID: 101746347 Publication Model: eCollection Cited Medium: Internet ISSN: 2639-8028 (Electronic) Linking ISSN: 26398028 NLM ISO Abbreviation: Crit Care Explor Subsets: PubMed not MEDLINE
أسماء مطبوعة: Original Publication: Philadelphia, PA : Wolters Kluwer Health, [2019]-
مستخلص: Approximately one in 30 patients with acute respiratory failure (ARF) undergoes an inter-ICU transfer. Our objectives are to describe inter-ICU transfer patterns and evaluate the impact of timing of transfer on patient-centered outcomes.
Design: Retrospective, quasi-experimental study.
Setting: We used the Healthcare Cost and Utilization Project State Inpatient Databases in five states (Florida, Maryland, Mississippi, New York, and Washington) during 2015-2017.
Participants: We selected patients with International Classification of Diseases , 9th and 10th Revision codes of respiratory failure and mechanical ventilation who underwent an inter-ICU transfer ( n = 6,718), grouping as early (≤ 2 d) and later transfers (3+ d). To control for potential selection bias, we propensity score matched patients (1:1) to model propensity for early transfer using a priori defined patient demographic, clinical, and hospital variables.
Main Outcomes: Inhospital mortality, hospital length of stay (HLOS), and cumulative charges related to inter-ICU transfer.
Results: Six-thousand seven-hundred eighteen patients with ARF underwent inter-ICU transfer, 68% of whom ( n = 4,552) were transferred early (≤ 2 d). Propensity score matching yielded 3,774 well-matched patients for this study. Unadjusted outcomes were all superior in the early versus later transfer cohort: inhospital mortality (24.4% vs 36.1%; p < 0.0001), length of stay (8 vs 22 d; p < 0.0001), and cumulative charges ($118,686 vs $308,977; p < 0.0001). Through doubly robust multivariable modeling with random effects at the state level, we found patients who were transferred early had a 55.8% reduction in risk of inhospital mortality than those whose transfer was later (relative risk, 0.442; 95% CI, 0.403-0.497). Additionally, the early transfer cohort had lower HLOS (20.7 fewer days [13.0 vs 33.7; p < 0.0001]), and lower cumulative charges ($66,201 less [$192,182 vs $258,383; p < 0.0001]).
Conclusions and Relevance: Our study is the first to use a large, multistate sample to evaluate the practice of inter-ICU transfers in ARF and also define early and later transfers. Our findings of favorable outcomes with early transfer are vital in designing future prospective studies evaluating evidence-based transfer procedures and policies.
Competing Interests: The authors have disclosed that they do not have any potential conflicts of interest.
(Copyright © 2022 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine.)
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معلومات مُعتمدة: U54 GM104941 United States GM NIGMS NIH HHS
فهرسة مساهمة: Keywords: early; inter-intensive care unit transfer; later; outcomes; respiratory failure; timing
تواريخ الأحداث: Date Created: 20220309 Latest Revision: 20220329
رمز التحديث: 20221213
مُعرف محوري في PubMed: PMC8893307
DOI: 10.1097/CCE.0000000000000642
PMID: 35261978
قاعدة البيانات: MEDLINE
الوصف
تدمد:2639-8028
DOI:10.1097/CCE.0000000000000642