Under-triage as a significant factor affecting transfer time between the emergency department and the intensive care unit

J Emerg Nurs. 2011 Sep;37(5):491-6. doi: 10.1016/j.jen.2011.01.016. Epub 2011 May 5.

Abstract

Introduction: The purpose of the study was to identify factors that affect transfer times between the emergency department and the intensive care unit (ICU) in a community hospital. Patients who are transferred from the emergency department to the ICU are usually in critical condition and in need of prompt treatment by qualified personnel. As a result of delayed transfers, a patient may experience complications, such as increased mortality rates and longer hospital stays.

Methods: A quantitative descriptive correlational design was used in this study. Data were collected from the charts of 75 patients who were transferred from the emergency department to the ICU of a 142-bed community hospital in the eastern United States. "Delayed patients" were identified as those who were transferred after more than 4 hours.

Results: Forty-four patients (58.7%) spent more than 4 hours in the emergency department. Nineteen out of 25 patients (76%) with an Emergency Severity Index designation of 3 were identified as delayed. Delayed status and an Emergency Severity Index designation of 3 showed a significant correlation (r = -.339, P = .004). Eleven patients (64.7%) diagnosed with sepsis were delayed, compared with 6 who were not delayed. A total of 70.4% of female patients were delayed, compared with 52.1% of male patients.

Discussion: This study provides a more comprehensive view of the factors involved in delayed patient transfer and provides data needed for effective interventions to be developed. The results suggest significant problems with the under-triage of critically ill patients, specifically patients with sepsis. Future research should include a larger group of subjects and a multifactorial analysis.

Publication types

  • Comparative Study

MeSH terms

  • Age Factors
  • Critical Illness / mortality
  • Critical Illness / therapy
  • Emergency Service, Hospital / statistics & numerical data*
  • Emergency Treatment / standards
  • Emergency Treatment / trends
  • Evaluation Studies as Topic
  • Female
  • Hospital Mortality / trends
  • Hospitals, Community
  • Humans
  • Intensive Care Units / statistics & numerical data*
  • Male
  • Needs Assessment
  • Patient Transfer / standards
  • Patient Transfer / trends*
  • Risk Factors
  • Sepsis / diagnosis
  • Sepsis / therapy*
  • Sex Factors
  • Time Factors
  • Treatment Outcome
  • Triage*
  • United States