Outcomes of traumatically injured patients after nighttime transfer from the intensive care unit

Amy Howk; Devin John Clegg; Jacob C Balmer; Natalie G Foster; Justin Gerard; Anthony S Rowe; Brian Daley

doi:10.1136/tsaco-2024-001451

Outcomes of traumatically injured patients after nighttime transfer from the intensive care unit

Trauma Surg Acute Care Open. 2024 Nov 26;9(1):e001451. doi: 10.1136/tsaco-2024-001451. eCollection 2024.

Authors

Amy Howk¹, Devin John Clegg², Jacob C Balmer¹, Natalie G Foster³, Justin Gerard⁴, Anthony S Rowe¹, Brian Daley⁵

Affiliations

¹ The University of Tennessee Medical Center, Knoxville, Tennessee, USA.
² Surgery, The University of Tennessee Graduate School of Medicine, Knoxville, Tennessee, USA.
³ The University of Tennessee Health Science Center, Memphis, Tennessee, USA.
⁴ Surgery, The University of Tennessee Medical Center, Knoxville, Tennessee, USA.
⁵ Surgical Critical Care, University of Tennessee Medical Center, Knoxville, Tennessee, USA.

Abstract

Background: Prior studies have associated nighttime transfer of patients from the intensive care unit (ICU) with increased morbidity. This study sought to examine this relationship in traumatically injured patients, as this has not been previously performed.

Methods: A retrospective review of traumatically injured patients admitted to a Level I Trauma Center's ICU from January 2021 to September 2022 was performed. "Day shift" (DS) was defined as 07:00 to 19:00 and "night shift" (NS) as 19:01 to 06:59. The time of transfer completion was based on the time of the patient arrival at the destination unit. The univariate analysis compared patients with completed transfers during DS and NS. Multivariate logistic regression was performed to predict readmission to the ICU.

Results: A total of 1,800 patients were included in the analysis, with 608 patients that had completed transfers during NS, and 1,192 during DS. Both groups were similar, with no significant differences in age, sex, Injury Severity Score (ISS), mechanism of injury, or median total comorbidities. The NS group had a longer median time to transfer completion (10.1 (IQR 5.5-13.6) hours vs 5.1 (IQR 2.9-8.4) hours; p<0.001). A significantly higher proportion of the NS group had a readmission to the ICU (60 (10.0%) vs 86 (7.0%); p=0.03) or a major complication (72 (11.9%) vs 107 (9.0%); p=0.048). When controlling for age, comorbidities, ISS, time to bed assignment and to transfer completed, and ICU length of stay, transfer completion during NS was associated with 1.56 times higher odds of having an ICU readmission (OR 1.56 (95% CI 1.05, 2.33); p=0.03).

Conclusions: Trauma patients transferred from the ICU during NS experienced longer delays, readmission to the ICU, and major complications significantly more often. With increasing hospital bed shortages, patient transfers must be analyzed to minimize worsened outcomes, especially in traumatically injured patients.

Level of evidence: Level III, therapeutic/care management.

Keywords: intensive care units; outcomes; transfer.