• Kyan Cyrus Safavi, Jazmin Furtado, Zenteno Langle Ana Cecilia AC Massachusetts General Hospital, Department of Perioperative Services, 55 Fruit Street, Boston, MA 02114, USA., David Scheinker, Ulrich Schmidt, Bethany Daily, Retsef Levi, and Peter Francis Dunn.
• Massachusetts General Hospital, Department of Anesthesia, Critical Care and Pain Medicine, 55 Fruit Street, Boston, MA 02114, USA. Electronic address: ksafavi@partners.org.
• J Crit Care. 2019 Apr 1; 50: 126-131.

PurposeThe impact of non-clinical transfer delay (TD) from the ICU to a general care unit on the progress of the patient's care is unknown. We measured the association between TD and: (1) the patient's subsequent hospital length of stay (LOS); (2) the timing of care decisions that would advance patient care.MethodsThis was a single center retrospective study in the United States of patients admitted to the surgical and neurosurgical ICUs during 2013 and 2015. The primary outcome was hospital LOS after transfer request. The secondary outcome was the timing of provider orders representing care decisions (milestones) that would advance the patient's care. Patient, surgery, and bed covariates were accounted for in a multivariate regression and propensity matching analysis.ResultsOut of the cohort of 4,926 patients, 1,717 met inclusion criteria. 670 (39%) experienced ≥12 hours of TD. For each day of TD, there was an average increase of 0.70 days in LOS (P < 0.001). The last milestone occurred on average 0.35 days later (P < 0.001). Propensity matching analyses were confirmatory (P < 0.001, P < 0.001).ConclusionsTD is associated with longer LOS and delays in milestone clinical decisions that progress care. Eliminating delays in milestones could mitigate TD's impact on LOS.Copyright © 2018 Elsevier Inc. All rights reserved.

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