Critical Care Utilization and Outcomes of Interhospital Medical Transfers at Lower Risk of Death

2021 ◽  
pp. 088506662110226
Author(s):  
Saqib H. Baig ◽  
Deborah J. Gorth ◽  
Erika J. Yoo
Keyword(s):  
Logistic Regression ◽  
Critically Ill ◽  
Negative Binomial ◽  
Cohort Analysis ◽  
Care Utilization ◽  
Medical Patients ◽  
Risk Of Death ◽  
Interhospital Transfer ◽  
Retrospective Cohort Analysis ◽  
Apache Iv

Purpose: To evaluate utilization and mortality outcomes of interhospital transferred critically-ill medical patients with lower predicted risk of hospital mortality. Materials & Methods: Multisite retrospective cohort analysis of patients with Acute Physiology and Chronic Health Evaluation (APACHE) IV-a predicted mortality of ≤20% from 335 ICUs in 208 hospitals in the Philips eICU database between 2014-2015. Differences in length-of-stay (LOS) and mortality between transferred and local patients were evaluated using negative binomial logistic regression and logistic regression, respectively. Stratified analyses were conducted for subgroups of predicted mortality: 0%-5%, 6%-10%, 11%-15%, and 16%-20%. Results: Transfers had a higher risk of longer ICU and hospital LOS across all risk strata (IRR 1.12; 95% CI 1.09-1.16, P < 0.001 and IRR 1.11; 95% CI 1.07-1.14, P < 0.001 respectively). Mortality was higher among transfers, largely driven by the 6%-10% mortality risk strata (OR 1.30; 95% CI 1.09-1.54, P = 0.003). Conclusions: Interhospital transfer of critically-ill medical patients with lower illness severity is associated with higher ICU and hospital utilization and increased mortality. Better understanding of factors driving patient selection for and characteristics of interhospital transfer for this population will have an impact on ICU resource utilization, care efficiency, and hospital quality.

Recent Trends in Admission Diagnosis and Related Mortality in the Medically Critically Ill

2020 ◽  
pp. 088506662098290
Author(s):  
Nicholas E. Ingraham ◽  
Victor Vakayil ◽  
Kathryn M. Pendleton ◽  
Alexandria J. Robbins ◽  
Rebecca L. Freese ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Critically Ill ◽  
Negative Binomial ◽  
Cohort Analysis ◽  
Temporal Trends ◽  
Negative Binomial Regression ◽  
Organ System ◽  
Admission Diagnosis ◽  
Icu Mortality ◽  
System Disease

Purpose: With decades of declining ICU mortality, we hypothesized that the outcomes and distribution of diseases cared for in the ICU have changed and we aimed to further characterize them. Study Design and Methods: A retrospective cohort analysis of 287,154 nonsurgical-critically ill adults, from 237 U.S. ICUs, using the manually abstracted Cerner APACHE Outcomes database from 2008 to 2016 was performed. Surgical patients, rare admission diagnoses (<100 occurrences), and low volume hospitals (<100 total admissions) were excluded. Diagnoses were distributed into mutually exclusive organ system/disease-based categories based on admission diagnosis. Multi-level mixed-effects negative binomial regression was used to assess temporal trends in admission, in-hospital mortality, and length of stay (LOS). Results: The number of ICU admissions remained unchanged (IRR 0.99, 0.98-1.003) while certain organ system/disease groups increased (toxicology [25%], hematologic/oncologic [55%] while others decreased (gastrointestinal [31%], pulmonary [24%]). Overall risk-adjusted in-hospital mortality was unchanged (IRR 0.98, 0.96-1.0004). Risk-adjusted ICU LOS (Estimate −0.06 days/year, −0.07 to −0.04) decreased. Risk-adjusted mortality varied significantly by disease. Conclusion: Risk-adjusted ICU mortality rate did not change over the study period, but there was evidence of shifting disease burden across the critical care population. Our data provides useful information regarding future ICU personnel and resource needs.

scholarly journals Evaluating mortality and recovery of extreme hyperbilirubinemia in critically ill patients by phasing the peak bilirubin level: A retrospective cohort study

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0255230
Author(s):  
Hong Seok Han ◽  
Chi-Min Park ◽  
Dae-Sang Lee ◽  
Dong Hyun Sinn ◽  
Eunmi Gil
Keyword(s):  
Hospital Mortality ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Retrospective Cohort ◽  
Total Bilirubin ◽  
Medical Center ◽  
Cohort Analysis ◽  
Grade Point ◽  
Retrospective Cohort Analysis ◽  
Grade 3

Background Hyperbilirubinemia is a devastating complication in patients admitted to an intensive care unit (ICU). The sequential organ failure assessment (SOFA) score classifies hyperbilirubinemia without further detailed analyses for bilirubin increase above 12 mg/dL. We evaluated whether the level of bilirubin increase in patients with extreme hyperbilirubinemia (total bilirubin ≥ 12 mg/dL) affects and also helps estimate mortality or recovery. Methods A retrospective cohort analysis comprising 427 patients with extreme hyperbilirubinemia admitted to the ICU of Samsung Medical Center, Seoul, Korea between 2011 and 2015 was conducted. Extreme hyperbilirubinemia was classified into four grades: grade 1 (12–14.9 mg/dL), grade 2 (15–19.9 mg/dL), grade 3 (20–29.9 mg/dL), and grade 4 (≥ 30 mg/dL). These grades were then assessed for their association with hospital mortality and recovery from hyperbilirubinemia to SOFA grade (point) 2 or below (total bilirubin < 6 mg/dL). The influences of various factors, some of which caused extreme hyperbilirubinemia, while others induced bilirubin recovery, were assessed. Results A total of 427 patients (mean age: 59.8 years, male: 67.0%) were evaluated, and the hospital mortality for these patients was very high (76.1%). Extreme hyperbilirubinemia was observed in 111 (grade 1, 26.0%), 99 (grade 2, 23.2%), 131 (grade3, 30.7%), and 86 (grade 4, 20.1%) patients with mortality rates of 62.2%, 71.7%, 81.7%, and 90.7%, respectively (p < 0.001). The peak bilirubin value correlated with the mortality (odds ratio [OR], 1.09; 95% confidence interval [CI], 1.04–1.15, p < 0.001). Compared to those with grade 1 extreme hyperbilirubinemia, the mortality rate gradually increased as the grade increased (OR [95% CI]: 1.92 [0.70–5.28], 3.55 [1.33–9.48], and 12.47 [3.07–50.59] for grades 2, 3 and 4, respectively). The main causes of extreme hyperbilirubinemia were infection including sepsis and hypoxic hepatitis. The recovery from hyperbilirubinemia was observed in 110 (25.8%) patients. Mortality was lower for those who recovered from hyperbilirubinemia than for those who did not (29.1% vs. 92.4%, p < 0.001). The favorable factors of bilirubin recovery were albumin and ursodeoxycholic acid (UDCA). Conclusions This study determined that the level of extreme hyperbilirubinemia is an important prognostic factor in critically ill patients. We expect the results of this study to help predict the clinical course of and determine the optimal treatment for extreme hyperbilirubinemia.

scholarly journals Analysis of Factors Affecting the Length of Stay in the Emergency Department for Critically Ill Patients Transferred to Regional Emergency Medical Centers

2022 ◽  
Author(s):  
Hyungbok Lee ◽  
Sangrim Lee ◽  
Hyeoneui Kim
Keyword(s):  
Emergency Department ◽  
Logistic Regression ◽  
Length Of Stay ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Prediction Models ◽  
Emergency Operation ◽  
Factors Affecting ◽  
Interhospital Transfer ◽  
Triage Level

Abstract BackgroundTransferring an emergency patient to another emergency department (ED) is necessary when she/he is unable to receive necessary treatment from the first visited ED, although the transfer poses potential risks for adverse clinical outcomes and lowering the quality of emergency medical services by overcrowding the transferred ED. This study aimed to understand the factors affecting the ED length of stay (LOS) of critically ill patients and to investigate whether they are receiving prompt treatment through Interhospital Transfer (IHT).MethodsThis study analyzed 968 critically ill patients transferred to the ED of the study site in 2019. Machine learning based prediction models were built to predict the ED LOS dichotomized as greater than 6 hours or less. Explanatory variables in patient characteristics, clinical characteristics, transfer-related characteristics, and ED characteristics were selected through univariate analyses.ResultsAmong the prediction models, the Logistic Regression (AUC 0.85) model showed the highest prediction performance, followed by Random Forest (AUC 0.83) and Naïve Bayes (AUC 0.83). The Logistic Regression model suggested that the need for emergency operation or angiography (OR 3.91, 95% CI=1.65–9.21), the need for Intensive Care Unit (ICU) admission (OR 3.84, 95% CI=2.53–5.83), fewer consultations (OR 3.57, 95% CI=2.84–4.49), a high triage level (OR 2.27, 95% CI=1.43–3.59), and fewer diagnoses (OR 1.32, 95% CI=1.09–1.61) coincided with a higher likelihood of 6-hour-or-less stays in the ED. Furthermore, an interhospital transfer handoff led to significantly shorter ED LOS among the patients who needed emergency operation or angiography, or ICU admission, or had a high triage level.ConclusionsThe results of this study suggest that patients prioritized in emergency treatment receive prompt intervention and leave the ED in time. Also, having a proper interhospital transfer handoff before IHT is crucial to provide efficient care and avoid unnecessarily longer stay in ED.

scholarly journals Acute Kidney Injury Classified by Serum Creatinine and Urine Output in Critically Ill Cancer Patients

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Bertha M. Córdova-Sánchez ◽  
Ángel Herrera-Gómez ◽  
Silvio A. Ñamendys-Silva
Keyword(s):  
Acute Kidney Injury ◽  
Serum Creatinine ◽  
Cancer Patients ◽  
Critically Ill ◽  
Urine Output ◽  
Cohort Analysis ◽  
Kidney Injury ◽  
Risk Of Death ◽  
Increased Risk ◽  
Stage 1

Acute kidney injury (AKI) is common in critically ill patients and is associated with higher mortality. Cancer patients are at an increased risk of AKI. Our objective was to determine the incidence of AKI in our critically ill cancer patients, using the criteria of serum creatinine (SCr) and urine output (UO) proposed by the Kidney Disease: Improving Global Outcomes (KDIGO).Methods.We performed a retrospective cohort analysis of a prospectively collected database at the intensive care unit (ICU) of the Instituto Nacional de Cancerología from January 2013 to March 2015.Results.We classified AKI according to the KDIGO definition. We included 389 patients; using the SCr criterion, 192 (49.4%) had AKI; using the UO criterion, 219 (56.3%) had AKI. Using both criteria, we diagnosed AKI in 69.4% of patients. All stages were independently associated with six-month mortality; stage 1 HR was 2.04 (95% CI 1.14–3.68,p=0.017), stage 2 HR was 2.73 (95% CI 1.53–4.88,p=0.001), and stage 3 HR was 4.5 (95% CI 2.25–8.02,p<0.001). Patients who fulfilled both criteria had a higher mortality compared with patients who fulfilled just one criterion (HR 3.56, 95% CI 2.03–6.24,p<0.001).Conclusion.We diagnosed AKI in 69.4% of patients. All AKI stages were associated with higher risk of death at six months, even for patients who fulfilled just one AKI criterion.

scholarly journals Role of organisational factors on the ‘weekend effect’ in critically ill patients in Brazil: a retrospective cohort analysis

BMJ Open ◽  
2018 ◽  
Vol 8 (1) ◽  
pp. e018541 ◽  
Author(s):  
Fernando G Zampieri ◽  
Thiago C Lisboa ◽  
Thiago D Correa ◽  
Fernando A Bozza ◽  
Marcus Ferez ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Retrospective Cohort ◽  
Cohort Analysis ◽  
Weekend Effect ◽  
Retrospective Cohort Analysis ◽  
Organisational Factors
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