Analyzing the impact of delays for patient transfers from the ICU to general care units

Abstract

Patients at Massachusetts General Hospital (MGH) face significant non-clinical transfer delays out of adult intensive care units (ICUs) and into general care units. In each of the years 2010 through to 2013, approximately 28% of MGH ICU patients experienced a transfer delay of over 12 hours. Transfer delays from the ICU impact several aspects of a patient's hospital stay, in that transfer delays: i) Increase the cost of the stay; ii) Increase ICU utilization; iii) May contribute to additional disruptions to patient flow, such as congested access to the ICU from various locations in the hospital; iv) May have clinical implications given that delayed ICU access for critically ill emergency department and operating room patients may affect the clinical care for these patients. In addition to these impacts, this study identifies a new, additional impact that is central to this work. This finding is that transfer delays from ICUs extend a patient's total hospital length-of-stay (LOS). Specifically, our analyses show that patients spend approximately the same amount of time in the hospital after their ICU stay (i.e., in a general care unit), regardless of whether or not they were delayed in the ICU. Essentially, this implies that for each day a patient is delayed in the ICU, an additional day is added to the patient's total LOS in the hospital. For certain patients, this additional amount of time, which is added to the patient's LOS, may be more than one day. Note that this phenomenon accentuates the other adverse consequences outlined above, since longer patient LOSs further increase congestion in units (both in the ICUs themselves and in general care units), and further impede access into ICUs, disrupting patient care and increasing overall hospital costs. This work studies non-clinical transfer delays from ICUs, and in doing so: 1) Develops a methodology to identify and quantify the magnitude of non-clinical transfer delays from ICUs; 2) Estimates the impact that non-clinical transfer delays from ICUs have on the total patient length of stay (LOS); 3) Identifies the reasons why delays in transfers from ICUs impact patient length of stay; 4) Proposes potential interventions to reduce the impact that delays in transfers from ICUs have on hospital operations.