Akron General Medical Center, Akron, OH
Floor-to-Unit Transfers Within 24 Hours of Admission from the ED

Abstract

Background: We are a community hospital with approximately 500 beds, 25,000 annual admissions, and 103,000 ED visits at 4 ED sites. The perception among residents was that a high number of patients were being admitted to a medicine floor from the ED but required transfer to a critical care unit within 24 hours of admission. We investigated this transition-of-care question and attempted to answer whether a change occurred in patient status, whether the status change could have been anticipated, and whether the initial admission unit was appropriate.

Methods: We performed a medical record audit of 5,302 admissions from January 1, 2014 through March 31, 2014 to identify patients who were transferred to an ICU within 24 hours of admission. Twenty-two patients met the criteria. We manually reviewed these medical records to determine admitting diagnosis, reason for transfer, time to transfer, and final patient disposition. Based on this data and our review of the record, we determined whether the initial placement was appropriate and whether any status change could have been anticipated.

Results: No patients died while in the hospital, and 50% were discharged home. The average time to transfer was 11:46 hours. Approximately 27% of transfers were felt to be due to questionable initial placement; however, no clear pattern of cause was identified. Fifty percent of the transfers were due to respiratory decompensation.

Conclusions: Reports from residents of unnecessary transfers within 24 hours from admission seemed to be a somewhat pervasive problem, but our study found the opposite: the number of transfers was much lower than expected. Although 50% of transfers were due to respiratory decompensation, without data on the total number of patients admitted for respiratory diagnoses, it is impossible to quantify the risk. In the future, we would like to explore standardized handoffs such as I-PASS to help admitting teams anticipate possible status changes.