دورية أكاديمية
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.
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. |
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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.) |
References: | N Engl J Med. 2001 Nov 8;345(19):1368-77. (PMID: 11794169) Crit Care Med. 2008 Oct;36(10):2779-86. (PMID: 18828201) Health Care Financ Rev. 2001 Winter;23(2):1-18. (PMID: 12500335) Arch Intern Med. 2011 Nov 28;171(21):1879-86. (PMID: 22123793) Acad Emerg Med. 2001 Jul;8(7):758-60. (PMID: 11435197) Health Care Financ Rev. 2002 Spring;23(3):171-2. (PMID: 12500355) J Crit Care. 2007 Dec;22(4):290-5. (PMID: 18086399) Chest. 2020 Dec;158(6):2381-2393. (PMID: 32682771) J Trauma. 1999 Nov;47(5):964-9. (PMID: 10568731) Ann Intern Med. 2003 Jun 3;138(11):882-90. (PMID: 12779298) JAMA. 2014 Apr 23-30;311(16):1632-40. (PMID: 24756513) J Hosp Med. 2013 Feb;8(2):76-82. (PMID: 23335231) Crit Care Med. 2004 Jan;32(1):256-62. (PMID: 14707589) JAMA. 2011 Oct 19;306(15):1659-68. (PMID: 21976615) Crit Care Med. 2007 Jun;35(6):1477-83. (PMID: 17440421) Am J Respir Crit Care Med. 2015 Jan 15;191(2):177-85. (PMID: 25478681) J Clin Epidemiol. 1992 Jun;45(6):613-9. (PMID: 1607900) Front Med (Lausanne). 2020 Oct 26;7:589553. (PMID: 33195353) Crit Care Med. 2006 Jul;34(7):1925-34. (PMID: 16715030) Crit Care Med. 2005 Jun;33(6):1266-71. (PMID: 15942342) Am J Epidemiol. 2011 Mar 15;173(6):676-82. (PMID: 21330339) Crit Care Med. 2005 Apr;33(4):705-10. (PMID: 15818092) Crit Care Med. 2014 Aug;42(8):1749-55. (PMID: 24717459) JAMA. 2002 Jan 16;287(3):345-55. (PMID: 11790214) J Chronic Dis. 1987;40(5):373-83. (PMID: 3558716) Am J Respir Crit Care Med. 2008 Feb 1;177(3):285-91. (PMID: 18006884) JAMA. 2000 Dec 6;284(21):2762-70. (PMID: 11105183) J Crit Care. 2009 Mar;24(1):108-13. (PMID: 19272546) Intensive Care Med. 2009 May;35(5):816-25. (PMID: 19288079) J Health Econ. 2005 May;24(3):465-88. (PMID: 15811539) Stat Sci. 2010 Feb 1;25(1):1-21. (PMID: 20871802) N Engl J Med. 2006 Jul 6;355(1):41-50. (PMID: 16822995) Crit Care Med. 2019 Nov;47(11):1564-1571. (PMID: 31393321) Ann Am Thorac Soc. 2017 May;14(5):730-736. (PMID: 28199137) Crit Care Med. 2010 Oct;38(10):1947-53. (PMID: 20639743) Chest. 2015 Jul;148(1):79-92. (PMID: 25927593) Crit Care. 2014 Aug 23;18(4):485. (PMID: 25148726) Crit Care Med. 2009 Jul;37(7):2149-54. (PMID: 19455025) Med Care. 2009 Jul;47(7):787-93. (PMID: 19536030) |
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 |
تدمد: | 2639-8028 |
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DOI: | 10.1097/CCE.0000000000000642 |