The paper "Impact of Delayed Transfer of Critically Ill Patients by Chalfin, Trzeciak, Likourezos, and Baumann" is a delightful example of an article on nursing. Delays in transferring critically ill patients from the emergency department to the critical care units do occur and may have an impact on the outcome for these patients. The Project IMPACT database was employed to provide a sample of 50,322 patients during the period 2000 to 2003 to do a comparative evaluation on the impact of delay of less than six-hour with a delay of six hours or more in transferring patients from the emergency department to the critical care units.
The findings of the study showed that there was a significant increase in median hospital length of stay, intensive care unit mortality rates, and in-hospital mortality rates in patients with a delay in transfer of six or more hours, leading the study to conclude that a delay of six hours or more in transferring patients from the emergency department to critical care increases the length of stay in hospital, and increases the mortality rates in the hospital and the critical care units for these patients. Introduction: The research article pertaining to the emergency department chosen for analysis is Chalfin, Trzeciak, Likourezos, Baumann, & Dellinger, 2007, Impact of Delayed Transfer of Critically Ill Patients from the Emergency Department to the Intensive Care Unit, which was published in Critical Care Medicine.
Summary: Delays do occur in the transfer of the critically ill from the emergency department to the critical care units, but there is scant literature evaluating the impact of these delays on patient outcomes.
This study aims to contribute to closing this gap in knowledge. The data for the study was obtained from the Project IMPACT database, with the sample consisting of patients that were admitted to the intensive care units from the emergency departments during the period 2000 to 2003. The sample size was 50,322 patients. Patients were divided into two groups consisting of those with a delay of fewer than six hours in the transfer and those with a delay of six hours or more for a comparative study.
The two groups were statistically compared using chi-square, Mann-Whitney, and unpaired Students t-tests. The results obtained showed that there was a significant increase in median hospital length of stay, intensive care unit mortality rates, and in-hospital mortality rates in patients with a delay in transfer of six or more hours, leading the study to conclude that a delay of six hours or more in transferring patients from the emergency department to critical care units increases the length of stay in hospital and higher intensive care unit and hospital mortality. The study suggests that additional studies are required to identify factors that are responsible for this delay, and the specific factors associated with the adverse outcomes (Chalfin, Trzeciak, Likourezos, Baumann, & Dellinger, 2007).
Analysis: The type of research involved in the study is an observational cross-sectional analytical study. The reason for arriving at this conclusion is that data from the earlier Project IMPACT is the data employed by the study for its statistical analysis to arrive at the observations of the impact of delays in transferring critically ill patients from the emergency departments to critical care units (Abrahams, 2000).
Critical Appraisal Worksheet: Data involved in this cross-sectional analytical study is from the Project Impact (PI) database, which is a large voluntary administrative database, developed by the Society for Critical Care Medicine in 1996 and intended for the critically ill. Nearly 120 adult ICU’ s from about ninety hospitals around the US are participants in the database, contributing data for more than 200,000 patients. Thus the database offers a reliable source of cross-sectional data for studies focusing on critically ill patients.
This study has collated data of a period of three years, leading to a sample size of 50,322 and has adequate coverage of the ICUs of the different disciplines of medicine. Patient baseline characteristics employed for the extraction of data were demographic data (including age, gender, presence of a do-not-resuscitate order, and presence of any advance directive), Acute Physiology and Chronic Health Evaluation (APACHE) II diagnostic category, and APACHE II severity score. The APACHE II severity score is based on the worst values for physiologic and laboratory data during the first 24 hrs after ICU presentation.
Primary outcome measurements that were abstracted were ICU mortality, in-hospital mortality, and hospital and ICU length of stay. Thus issues of randomization, percentage of participants participating in the study, and duration of study have been addressed adequately by the study. There was similarity in age, gender, and do-not-resuscitate status, along with the Acute Physiology and Chronic Health Evaluation II score. The reliability of the evaluation of the data comes from the use of adequate statistical means such as chi-square, Mann-Whitney, and unpaired Students t-tests (Grafen & Hails, 2003) The instrument used by study is deficient in analyzing the impact of delayed admission from a continuous standpoint over time.
The authors themselves admit this in their use of the dichotomous variable of six hours or more delay in transfer, which is the instrument used in the study. They provide justification in that it correlates with the 5.8 hours mean time to transfer as seen in US hospitals, where overcrowding is an issue. This dichotomous variable is a critical element in the study, and yet it does not appear to have universal validity, for the average time of stay in the emergency department may be much lower in Europe at 176 minutes (Bucheli & Martina, 2004).
The confidence level has the usual precision of 95% (0.561-0.895). The use of data pertaining to a number of critical care units in hospitals spread over the US makes the outcomes significant to patients passing through the emergency department of my hospital. The discussion segment of the study provides clarity to the results obtained from the statistical evaluation and understanding of the manner in which the findings of the study have been arrived at (Grafen & Hails, 2003) Implications: The study does have implications in improving the quality and standards in the delivery of healthcare services to the many patients passing through the emergency departments and their outcomes in any hospital.
It involves all the professionals providing services in the emergency and critical care departments, and the hospital administration. In the discussion of this article the issues that contribute to delay in transfer from emergency departments to critical care units have been pointed out and include, knowledge, skill, and staff levels of the professionals at the emergency department, availability of facilities at the emergency department, shortage of beds and understaffing of nursing professionals at the critical care units (Chalfin, Trzeciak, Likourezos, Baumann, & Dellinger, 2007).
The validity of the implications of this study can be seen by the reduction in the average length of stay in the emergency department by twenty-five minutes, through the addition of one emergency physician in the emergency department (Bucheli & Martina, 2004).