Non-clinical delays in transfer out of the surgical ICU are associated with increased hospital length of stay and delayed progress of care

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Purpose:The impact of non-clinical transfer delay (TD) from the ICU to a general care unit on the progress of the patient's care is unknown. We measured the association between TD and: (1) the patient's subsequent hospital length of stay (LOS); (2) the timing of care decisions that would advance patient care.Methods:This was a single center retrospective study in the United States of patients admitted to the surgical and neurosurgical ICUs during 2013 and 2015. The primary outcome was hospital LOS after transfer request. The secondary outcome was the timing of provider orders representing care decisions (milestones) that would advance the patient's care. Patient, surgery, and bed covariates were accounted for in a multivariate regression and propensity matching analysis.Results:Out of the cohort of 4,926 patients, 1,717 met inclusion criteria. 670 (39%) experienced ≥12 hours of TD. For each day of TD, there was an average increase of 0.70 days in LOS (P<0.001). The last milestone occurred on average 0.35 days later (P<0.001). Propensity matching analyses were confirmatory (P<0.001, P<0.001).Conclusions:TD is associated with longer LOS and delays in milestone clinical decisions that progress care. Eliminating delays in milestones could mitigate TD's impact on LOS.HIGHLIGHTSNon-clinical transfer delays from ICU to general care unit are a common bottleneck.Transfer delays from the ICU are associated with increased hospital length of stay.Transfer delays are also associated with delays in decisions that would advance care.Transfer delays affect length of stay and care decisions in a dose-dependent manner.ICUs should focus on continuing to advance care for transfer delayed patients.

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