Beyond Unplanned ICU Transfers: Linking a Revised Definition of Deterioration to Patient Outcomes

Author:

Byrd Thomas F.123,Phelan Tom A.4,Ingraham Nicholas E.25,Langworthy Benjamin W.6,Bhasin Ajay7,Kc Abhinab8,Melton-Meaux Genevieve B.239,Tignanelli Christopher J.2310

Affiliation:

1. Division of Hospital Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN.

2. Center for Learning Health System Sciences, University of Minnesota, Minneapolis, MN.

3. Institute for Health Informatics, University of Minnesota, Minneapolis, MN.

4. Fairview Health Services, Minneapolis, MN.

5. Division of Pulmonary and Critical Care, Department of Medicine, University of Minnesota, Minneapolis, MN.

6. Division of Biostatistics, University of Minnesota School of Public Health, Minneapolis, MN.

7. Division of Hospital Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.

8. University of Minnesota Medical School, Minneapolis, MN.

9. Division of Colon and Rectal Surgery, Department of Surgery, University of Minnesota, Minneapolis, MN.

10. Division of Acute Care Surgery, Department of Surgery, University of Minnesota, Minneapolis, MN.

Abstract

OBJECTIVES: To develop an electronic descriptor of clinical deterioration for hospitalized patients that predicts short-term mortality and identifies patient deterioration earlier than current standard definitions. DESIGN: A retrospective study using exploratory record review, quantitative analysis, and regression analyses. SETTING: Twelve-hospital community-academic health system. PATIENTS: All adult patients with an acute hospital encounter between January 1, 2018, and December 31, 2022. INTERVENTIONS: Not applicable. MEASUREMENTS AND MAIN RESULTS: Clinical trigger events were selected and used to create a revised electronic definition of deterioration, encompassing signals of respiratory failure, bleeding, and hypotension occurring in proximity to ICU transfer. Patients meeting the revised definition were 12.5 times more likely to die within 7 days (adjusted odds ratio 12.5; 95% CI, 8.9–17.4) and had a 95.3% longer length of stay (95% CI, 88.6–102.3%) compared with those who were transferred to the ICU or died regardless of meeting the revised definition. Among the 1812 patients who met the revised definition of deterioration before ICU transfer (52.4%), the median detection time was 157.0 min earlier (interquartile range 64.0–363.5 min). CONCLUSIONS: The revised definition of deterioration establishes an electronic descriptor of clinical deterioration that is strongly associated with short-term mortality and length of stay and identifies deterioration over 2.5 hours earlier than ICU transfer. Incorporating the revised definition of deterioration into the training and validation of early warning system algorithms may enhance their timeliness and clinical accuracy.

Publisher

Ovid Technologies (Wolters Kluwer Health)

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