Intra-hospital transfers to a higher level of care: Contribution to total hospital and intensive care unit (ICU) mortality and length of stay (LOS)


  • This work was supported by a grant from the Kaiser Foundation Health Plan Inc., Kaiser Foundation Hospitals, Inc., and The Permanente Medical Group, Inc. (“Early Detection of Impending Physiologic Deterioriation in Hospitalized Patients”). In addition, development work for some of the computer algorithms we employed was funded by the Sidney Garfield Memorial Fund.

  • Disclosure: Nothing to report.



Patients who experience intra-hospital transfers to a higher level of care (eg, ward to intensive care unit [ICU]) are known to have high mortality. However, these findings have been based on single-center studies or studies that employ ICU admissions as the denominator.


To employ automated bed history data to examine outcomes of intra-hospital transfers using all hospital admissions as the denominator.


Retrospective cohort study.


A total of 19 acute care hospitals.


A total of 150,495 patients, who experienced 210,470 hospitalizations, admitted to these hospitals between November 1st, 2006 and January 31st, 2008.


Predictors were age, sex, admission type, admission diagnosis, physiologic derangement on admission, and pre-existing illness burden; outcomes were: 1) occurrence of intra-hospital transfer, 2) death following admission to the hospital, 3) death following transfer, and 4) total hospital length of stay (LOS).


A total of 7,868 hospitalizations that began with admission to either a general medical surgical ward or to a transitional care unit (TCU) had at least one transfer to a higher level of care. These hospitalizations constituted only 3.7% of all admissions, but accounted for 24.2% of all ICU admissions, 21.7% of all hospital deaths, and 13.2% of all hospital days. Models based on age, sex, preadmission laboratory test results, and comorbidities did not predict the occurrence of these transfers.


Patients transferred to higher level of care following admission to the hospital have excess mortality and LOS. Journal of Hospital Medicine 2010;. © 2010 Society of Hospital Medicine.