Reese Jennifer, Deakyne Sara J, Blanchard Ashley, Bajaj Lalit
Sections of Hospital Medicine and
Research Informatics, Children's Hospital Colorado, Aurora, Colorado; and.
Hosp Pediatr. 2015 Jan;5(1):27-34. doi: 10.1542/hpeds.2013-0102.
Appropriate patient placement at the time of admission to avoid unplanned transfers to the ICU and codes outside of the ICU is an important safety goal for many institutions. The objective of this study was to determine if the overall rate of unplanned ICU transfers within 12 hours of admission to the inpatient medical/surgical unit was higher for direct admissions compared with emergency department (ED) admissions.
This was a retrospective cohort study of all unplanned ICU transfers within 12 hours of admission to an inpatient unit at a tertiary care children's hospital from January 2010 to December 2012. Proportions of preventable unplanned transfers from the ED and from direct admission were calculated and compared.
Over the study period, there were a total of 46,998 admissions; 279 unplanned ICU transfers occurred during the study period of which 101 (36%) were preventable. Preventable unplanned transfers from each portal of entry were calculated and compared with the total number of admissions from those portals. The portals of entry evaluated included admissions from our internal ED versus all outside facility transfers. The rates of early unplanned transfer (per 1000 admissions) by portal of entry were 3.50 for direct admissions and 3.18 for ED. There was no difference between direct admissions and ED admissions resulting in preventable unplanned transfers to the ICU (P=.64).
Rates of unplanned ICU transfers within 12 hours of admission to an inpatient unit are not higher for direct admissions compared with ED admissions. Further studies are required to determine clinical risk factors associated with unplanned ICU transfer after admission, thus allowing for more accurate initial patient placement.
许多机构的一项重要安全目标是在患者入院时进行恰当安置，以避免意外转入重症监护病房（ICU）以及在ICU之外进行急救。本研究的目的是确定与急诊科（ED）入院患者相比，直接入院患者入住内科/外科病房后12小时内意外转入ICU的总体发生率是否更高。
这是一项回顾性队列研究，研究对象为2010年1月至2012年12月期间在一家三级护理儿童医院内科病房入院后12小时内所有意外转入ICU的患者。计算并比较了来自急诊科和直接入院的可预防意外转入的比例。
在研究期间，共有46998例入院患者；研究期间发生了279例意外转入ICU的情况，其中101例（36%）是可预防的。计算了每个入院途径的可预防意外转入情况，并与这些途径的入院总数进行了比较。评估的入院途径包括来自本院急诊科的入院患者与所有外部机构转入的患者。按入院途径划分的早期意外转入率（每1000例入院患者），直接入院患者为3.50，急诊科入院患者为3.18。直接入院患者和急诊科入院患者导致可预防的意外转入ICU的情况之间没有差异（P = 0.64）。
与急诊科入院患者相比，直接入院患者入住内科病房后12小时内意外转入ICU的发生率并不更高。需要进一步研究以确定入院后与意外转入ICU相关的临床风险因素，从而实现更准确的初始患者安置。
