Out-of-Hospital ICU Transfers to an Oncological Referral Center: Characteristics, Resource Utilization, and Patient Outcomes

Cristina Gutierrez; Yenny R Cárdenas; Kristie Bratcher; Judd Melancon; Jason Myers; Jeannee Y Campbell; Lei Feng; Kristen J Price; Joseph L Nates

doi:10.1177/0885066616686536

Out-of-Hospital ICU Transfers to an Oncological Referral Center: Characteristics, Resource Utilization, and Patient Outcomes

J Intensive Care Med. 2019 Jan;34(1):55-61. doi: 10.1177/0885066616686536. Epub 2016 Dec 29.

Authors

Cristina Gutierrez¹, Yenny R Cárdenas², Kristie Bratcher¹, Judd Melancon¹, Jason Myers¹, Jeannee Y Campbell¹, Lei Feng³, Kristen J Price¹, Joseph L Nates¹

Affiliations

¹ 1 Division of Anesthesia and Critical Care, Critical Care Department, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
² 2 Critical Care Department, Fundación Santa Fe de Bogotá, Bogotá, Colombia.
³ 3 Division of Quantitative Sciences, Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston TX, USA.

PMID: 28030995
DOI: 10.1177/0885066616686536

Abstract

Objective:: To determine resource utilization and outcomes of out-of-hospital transfer patients admitted to the intensive care unit (ICU) of a cancer referral center.

Design:: Single-center cohort.

Setting:: A tertiary oncological center.

Patients:: Patients older than 18 years transferred to our ICU from an outside hospital between January 2013 and December 2015.

Measurements and main results:: A total of 2127 (90.3%) were emergency department (ED) ICU admissions and 228 (9.7%) out-of-hospital transfers. The ICU length of stay (LOS) was longer in the out-of-hospital transfers when compared to all other ED ICU admissions ( P = .001); however, ICU and hospital mortality were similar between both groups. The majority of patients were transferred for a higher level of care (77.2%); there was no difference in the amount of interventions performed, ICU LOS, and ICU mortality between nonhigher level-of-care and higher level-of-care patients. Factors associated with an ICU LOS ≥10days were a higher Sequential Organ Failure Assessment (SOFA) score, weekend admissions, presence of shock, need for mechanical ventilation, and acute kidney injury on admission or during ICU stay ( P < .008). The ICU mortality of transferred patients was 17.5% and associated risk factors were older age, higher SOFA score on admission, use of mechanical ventilation and vasopressors during ICU stay, and renal failure on admission ( P < .0001). Data related to the transfer such as LOS at the outside facility, time of transfer, delay in transfer, and longer distance traveled were not associated with increased LOS or mortality in our study.

Conclusion:: Organ failure severity on admission, and not transfer-related factors, continues to be the best predictor of outcomes of critically ill patients with cancer when transferred from other facilities to the ICU. Our data suggest that transferring critically ill patients with cancer to a specialized center does not lead to worse outcomes or increased resource utilization when compared to patients admitted from the ED.

Keywords: ICU outcomes; critically ill; oncological patients; out-of-hospital transfer; resource utilization.

MeSH terms

Adult
Cancer Care Facilities / statistics & numerical data*
Critical Illness / mortality
Critical Illness / therapy*
Female
Humans
Intensive Care Units* / statistics & numerical data
Length of Stay
Male
Middle Aged
Neoplasms / mortality
Neoplasms / therapy*
Organ Dysfunction Scores
Outcome Assessment, Health Care
Patient Transfer
Referral and Consultation*
Retrospective Studies