The mortality of critically ill patients was not associated with inter-hospital transfer due to a shortage of ICU beds -
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RESEARCH
Open Access
The mortality of critically ill patients was not associated with inter-hospital transfer due to a shortage of ICU beds - a singlecentre retrospective analysis Jonatan Oras* , Marko Strube and Christian Rylander
Abstract Background: Patients in the intensive care unit (ICU) are increasingly being transferred between ICUs due to a shortage of ICU beds, although this practice is potentially harmful. However, in tertiary units, the transfer of patients who are not in need of highly specialized care is often necessary. The aim of this study was to assess the association between a 90-day mortality and inter-hospital transfer due to a shortage of ICU beds in a tertiary centre. Methods: Data were retrieved from the local ICU database from December 2011 to September 2019. The primary analysis was a risk-adjusted logistic regression model. Secondary analyses comprised case/control (transfer/nontransfer) matching. Results: A total of 573 patients were transferred due to a shortage of ICU beds, and 8106 patients were not transferred. Crude 90-day mortality was higher in patients transferred due to a shortage of beds (189 patients (33%) vs 2188 patients (27%), p = 0.002). In the primary, risk-adjusted analysis, the risk of death at 90 days was similar between the groups (odds ratio 0.923, 95% confidence interval 0.75–1.14, p = 0.461). In the secondary analyses, a 90-day mortality was similar in transferred and non-transferred patients matched according to SAPS 3-score, age, days in the ICU and ICU diagnosis (p = 0.407); SOFA score on the day of discharge, ICU diagnosis and age (p = 0.634); or in a propensity score model (p = 0.229). Conclusion: Mortality at 90 days in critically ill patients treated in a tertiary centre was not affected by transfer to another intensive care units due to a shortage of beds. We found this conclusion to be valid under the assumption that patients are carefully selected and that the transports are safely performed. Keywords: Intensive care unit, Patient transfer, Transportation of patients, Logistics, Mortality
Background Inter-hospital transfer of critically ill patients between intensive care units (ICUs) is a common practice in Sweden [1]. This procedure is considered a means of providing best care when a patient in need of highly * Correspondence: [email protected] Department of Anaesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, 413 45 Gothenburg, Sweden
specialized procedures is transported to a tertiary centre. However, as elsewhere [2], patients are increasingly being transferred between ICUs due to a shortage of ICU beds. The number of ICU beds in Sweden is among the lowest in Europe, and the occupancy rate is constantly high [1, 3]. Transfer of selected ICU patients to another unit with available bed space is a frequent solution when the demand for new admittances exceeds the available capacity. Several hospitals employ dedicated
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