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Delay in transfer to the ICU increases risk of death

ORLANDO, Fla.--Patients delayed in being moved from a regular hospital ward to the intensive care unit (ICU) after suffering a deterioration in one of their vital signs such as a drop in blood pressure or a higher breathing rate may be at increased risk of death, according to a study presented at the American Thoracic Society International Conference in Orlando on May 24.

"In many hospitals, there are 6 to 8 patients per nurse, and 8 hours or more may pass between times when a patient's vital signs are taken," said lead researcher Michael Young, M.D., Assistant Professor of Medicine and Director of the Medical ICU at the University of Vermont/Fletcher Allen Health Care in Burlington. "Most hospitals lack explicit criteria to decide when a patient should be evaluated by a physician to determine whether the patient should be transferred to the ICU. We need validated standards that prompt urgent bedside evaluation of a patient 7 days a week, 24 hours a day. Timely physician bedside evaluation of hospitalized patients at risk for catastrophic deterioration could potentially prevent thousands of deaths each year."

Dr. Young and colleagues studied 47 patients at a teaching hospital who were transferred from a hospital ward to the medical/surgical ICU over five months. They determined when these 47 patients first met any of 11 pre-specified physiologic criteria, such as changes in breathing rate, blood pressure, heart rate and mental status. The researchers found that 48% of patients who were transferred to the ICU more than four hours after meeting one of the physiologic criteria either died or needed skilled care after hospital discharge, compared with 39% of those patients who were transferred in less than four hours. Patients who survived were transferred twice as quickly to the ICU than those that died.

"Our preliminary data suggests that once certain physiologic criteria are met such as a very low blood pressure or a deterioration in mental s
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Contact: Jim Augustine, Bill Glitz or Cathy Carlomagno
medsci@earthlink.net
407-685-4098
American Thoracic Society
24-May-2004


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