1. Cutugno, Christine PhD, RN

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According to this study:


* Patients transferred from the ICU to a regular ward at night have an increased risk of death compared with patients transferred during the day; however the difference between daytime and nighttime transfers was not statistically significant.


* Patients transferred at night also have a higher rate of ICU readmission and a significantly longer hospital length of stay.



Studies have shown that patients transferred from the ICU to a regular ward during the night shift have a significantly higher risk of dying than those transferred during the day. However, most of the hospitals studied were in large cities outside the United States, and had high ICU occupancy rates and busy EDs. Hanane and colleagues are associated with the Mayo Clinic in Rochester, Minnesota, a rural tertiary medical center whose ICU occupancy rates range from 55% to 81%; they decided to conduct a similar study to see if it would yield comparable results. They evaluated data from the Acute Physiology and Chronic Health Evaluation III database on 11,659 patients who were transferred from the ICU to general care wards between 2003 and 2006. Study outcomes were death, readmission to the ICU, and increased length of stay.


The authors determined that 418 patients (3.6% of the total) were transferred between 7 PM and 6:59 AM. These patients had a 5.3% risk of death compared with a 4.5% risk of death in those transferred between 7 AM and 6:59 PM, but the difference was not statistically significant. However, the authors did find that the rate of readmission to the ICU was higher and the hospital length of stay significantly longer for the patients transferred at night. Also, patients with comorbidities and high acuity scores had a significantly higher rate of negative outcomes.


Although the number of acute care hospital beds has decreased in the United States, the demand for ICU beds continues to increase, especially in urban areas. The shortage of intensive care physicians and ICU nurses further complicates this issue. Given the need to free up additional hospital beds, more studies are needed to determine the safest time to transfer patients and which patients can be most safely transferred.




Hanane T, et al. Crit Care Med 2008;36(8): 2232-7.