Epidemiology of unexpected intensive care unit (ICU) admissions from the hospital ward: A multi-centre retrospective study
CCCF ePoster library. Tam B. Oct 2, 2017; 198097
Dr. Benjamin Tam
Dr. Benjamin Tam
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Abstract
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Epidemiology of unexpected intensive care unit (ICU) admissions from the hospital ward: A multi-centre retrospective study

Tam, Benjamin1; Skitch, Steven2; Xu, MIchael3; Fox-Robichaud, Alison1 

1Department of Medicine, Division of Critical Care, McMaster University, Hamilton, Canada; 2Department of Emergency Medicine, McMaster University, Hamilton, Canada; 3Health Research Methodology Program, McMaster University, Hamilton, Canada


Background
Reducing hospital harm is an important patient safety goal. Unexpected ICU admissions from the ward are high morbidity, high cost events that are important to examine to improve patient safety. The objective of this study is to describe opportunities to improve care by characterizing the cause and timeline of unexpected ICU admissions from the ward in an academic, integrated, healthcare system.
 
Methods
We conducted a retrospective study of a consecutive cohort of patients admitted to eight general medical and surgical wards at two academic hospitals from January to June 2014. A team of trained reviewers abstracted charts for demographic data, co-morbid status, ward admission diagnosis, ICU admission diagnosis, ICU and hospital length of stay, unexpected ICU transfer, and death. Patients unexpectedly admitted to the ICU from the ward were included in the analysis. Patients admitted for routine post-operative monitoring were excluded unless the reason for surgery was unexpected. Two reviewers coded the diagnoses independently, met to compare coding and reviewed discrepancies as a team until agreement was reached. We described the cause and timeline of unexpected ICU admissions from the ward and compared the diagnosis leading to ICU admission with the diagnosis at ward admission.
 
Results
We analyzed 164 unexpected ICU admissions from 7130 total ward admissions. There were 23.0 unexpected ICU admissions / 1000 ward admissions. The three most common diagnostic conditions associated with unexpected ICU admission from the ward were, infection (22.6%), respiratory failure (18.3%), and CHF (9.1%).  71.5% of infections associated with ICU admissions were not noted at the time of ward admission.  We found that 50.6% of unexpected ICU admissions occurred within 3 days of ward admission, and 82.9% of ICU admissions occurred within 8 days.
 
Conclusion
Common reasons for unexpected ICU admission from the ward are infection, respiratory failure and CHF. The majority of infections leading to ICU admission are diagnosed after hospitalization. Unexpected ICU admissions typically occur within a week of hospitalization with half occurring within the first 3 days of hospitalization. Strategies to reduce the risk of unexpected ICU admission should focus on early prevention and management of infection, respiratory failure and CHF.
 

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