Outcomes and Cost Analysis of Patients with Sepsis Transferred to a Tertiary Care Intensive Care Unit
CCCF ePoster library. Fernando S. Oct 4, 2017; 198162; 111
Dr. Shannon Fernando
Dr. Shannon Fernando
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Outcomes and Cost Analysis of Patients with Sepsis Transferred to a Tertiary Care Intensive Care Unit

Fernando, Shannon M., MD, MSc1,2; Reardon, Peter M., MD1,2; Van Katwyk, Sasha, MSc3; Thavorn, Kednapa, PhD3; Tanuseputro, Peter, MD, MHSc4; Rosenberg, Erin, MD, MHA1; Perry, Jeffrey J.2,3; Seely, Andrew J. E., MD, PhD1,3,5; Kyeremanteng, Kwadwo, MD, MHA1,6  



1. Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, Canada; 2. Department of Emergency Medicine, University of Ottawa, Ottawa, Canada; 3. Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada; 4. Bruyere Research Institute, Ottawa, Canada; 5. Department of Surgery, University of Ottawa, Ottawa, Canada; 6. Division of Palliative Medicine, Department of Medicine, University of Ottawa, Ottawa, Canada. 


Background: Sepsis remains a major cause of mortality worldwide, and effective treatment is predicated upon early diagnosis and treatment. Some out-of-hospital evidence suggests that patients with a pre-hospital diagnosis of sepsis may benefit from bypass of peripheral centres without Intensive Care Unit (ICU) capability in order to be treated at tertiary care centres with more available resources. However, little is known at present regarding outcomes and costs of patients with sepsis transferred to tertiary care centres. 
 
Objectives: We evaluated ICU patient records in order to identify characteristics, outcomes and cost patterns for patients with sepsis that were transferred from a peripheral hospital, as compared to those admitted directly to a tertiary care centre. 
 
Methods: This retrospective cohort study was performed in two tertiary care hospital ICUs, within The Ottawa Hospital network. Patients were enrolled between January 1, 2011 and December 31, 2014. Patient characteristics and outcomes were gathered from The Ottawa Hospital Data Warehouse. Patients with a primary diagnosis of “sepsis” were identified and included in the analysis. Primary outcomes were ICU length of stay (LOS) and hospital costs. For cost analysis, the total cost per patient was measured and stored by the hospital Data Warehouse.
 
Results: 8502 patients were admitted to the ICU during the study period, of which 1172 had a primary diagnosis of sepsis. Of patients diagnosed with sepsis, 657 were admitted directly to a tertiary care centre, and 515 were transferred from peripheral centres. There was no significant difference in mortality (38.0 vs. 36.5, p = 0.59) or ICU LOS (9.7 [8.8, 10.6] vs. 11.11 [9.7-12.6], p = 0.10) between patients admitted directly to the tertiary care centre and transfers, respectively. No difference in mean total cost was found between direct admits and transfers ($61866 [58434-68939] vs. $66469 [53496-79442], p = 0.52). However, the mean cost per day was lower in direct admits, as compared to transfers ($3536 [3364-3707] vs. $3813 [3625-4000], p = 0.03). Overall, patients with a diagnosis of sepsis had an overall mortality of 37.3% and mean ICU LOS of 10.3 days (9.5, 11.2), compared to 25.6% and 7.8 days (7.5, 8.0), respectively, in all other patients admitted to the ICU during this time. Patients with sepsis had a mean total cost of $63900 (56973, 70827) and a mean cost per day of $3658 (3531, 3784), while all other ICU patients had a mean total cost of $58398 (54461, 62336) and mean cost per day of $3329 (3280, 3379).
 
Conclusions: In our cohort, patients with sepsis had higher mortality, ICU LOS and costs than other patients admitted to the ICU. There was no significant difference in mortality, ICU LOS and mean total cost between patients with sepsis admitted directly to a tertiary care centre and those transferred. However, transferred patients had a higher mean cost per day. These findings lend support to the current practice of initial treatment, stabilization and transfer of patients with sepsis at peripheral centres without ICU capability.

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