SHM Converge Scientific Abstract ePoster Gallery-Risk Factors for Escalation of Care From General Medical Units

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This quality improvement review examined factors associated with escalation of care from general medical units to the ICU at the University of Rochester Medical Center during 2019. Using EMR data from 1,225 adult medical admissions, the team analyzed age, time of ICU transfer, length of stay before transfer, diagnosis, care team type (resident vs APP), and discharge outcomes.<br /><br />The most common reason for ICU transfer was sepsis/infection (41%), followed by respiratory conditions. On average, patients were transferred to the ICU 5.5 days after hospital admission. Most transfers came from APP units (62%) rather than resident units (38%).<br /><br />Key findings showed that several factors were linked to worse outcomes, especially in-hospital death: older age, transfer occurring after hours (5 pm to 8 am), and longer delay before ICU transfer. Among patients who died after transfer, 69.6% were age 65 or older. More deaths occurred when ICU transfer happened overnight or in the evening (56% of deaths, 65/115).<br /><br />The authors conclude that older patients, particularly those over 65, may benefit from closer monitoring and proactive reassessment, such as afternoon reevaluation of at-risk patients. They also recommend earlier intervention, improved triage protocols, enhanced monitoring to prevent deterioration, and earlier use of palliative or hospice services where appropriate. Future Plan-Do-Study-Act cycles will focus on these interventions to reduce avoidable ICU transfers and improve patient outcomes.

Asset Subtitle

Yousaf Ali

Meta Tag

Author List Adam E. Bracken, Yousaf Ali

Category Research

Concept ICU Transfer

Concept Age

Concept After-Hours Transfer

Concept Sepsis

Concept Mortality

Distinguished Non-Finalist

Presenter Organization University of Rochester Medical Center

Presenting Author Yousaf Ali

Track Outcomes Research

Keywords

ICU transfer

quality improvement

medical admissions

sepsis

infection

older age

after-hours transfer

mortality

hospital escalation

patient monitoring

ICU Transfer

Age

After-Hours Transfer

Sepsis

Mortality