Department of Internal Medicine, Division of Hospital Medicine, Denver Health Medical Center, University of Colorado School of Medicine, Denver, Colorado 80204, USA.
J Hosp Med. 2011 Feb;6(2):68-72. doi: 10.1002/jhm.812. Epub 2010 Dec 13.
Unplanned intensive care unit (ICU) transfers may result from errors in care but the frequency of their occurrence, and whether these transfers might be prevented, has not been investigated.
To determine why unplanned transfers occur, what fraction results from errors in care, whether they are preceded by changes in clinical status and if so, whether earlier or different responses might prevent the transfers.
Retrospective study.
University-affiliated hospital.
All patients 18 to 89 years with unplanned transfers to the medical ICU from June 1, 2005 to May 30, 2006.
None.
Demographics, admission and transfer diagnoses, clinical triggers preceding the transfer, mortality, judgment by three reviewers about cause of transfer and whether it could have been prevented.
A total of 152 patients had unplanned transfers. The most common reasons were worsening of the problem for which the patient was admitted (48%) and development of a new problem (39%). Errors in care accounted for 29 transfers (19%), 15 of which were due to incorrect triage at the time of admission, and 14 due to iatrogenic errors. Of the 14 iatrogenic errors, the investigators determined that eight transfers might have been prevented by an earlier intervention. Agreement among the three reviewers was moderate to almost perfect (κ 0.55-0.90).
Although 19% of unplanned transfers to medical ICUs are associated with errors in care, almost 80% of these seem to be preventable. Most of the preventable errors resulted from inappropriate admission triage.
非计划性重症加强护理病房（ICU）转科可能是由于治疗失误引起的，但这种转科的发生频率以及是否可以预防尚未得到研究。
确定非计划性转科的原因，有多少是由于治疗失误引起的，在转科前是否有临床状态的变化，如果有，是否可以通过更早或不同的应对措施来预防转科。
回顾性研究。
大学附属医院。
所有年龄在 18 岁至 89 岁之间、2005 年 6 月 1 日至 2006 年 5 月 30 日期间非计划性转入内科 ICU 的患者。
无。
人口统计学资料、入院和转科诊断、转科前的临床触发因素、死亡率、由三位评审员判断转科的原因以及是否可以预防。
共有 152 名患者发生非计划性转科。最常见的原因是患者入院时的问题恶化（48%）和出现新问题（39%）。治疗失误导致 29 次转科（19%），其中 15 次是由于入院时分诊错误，14 次是由于医源性失误。在 14 次医源性失误中，研究人员确定 8 次转科可以通过更早的干预来预防。三位评审员的判断一致性为中度至近乎完美（κ 值为 0.55-0.90）。
尽管内科 ICU 非计划性转科的 19%与治疗失误有关，但其中近 80%似乎是可以预防的。大多数可预防的失误是由于入院分诊不当造成的。
