Unplanned Transfers from Hospital Wards to the Neurological Intensive Care Unit

The aim of this study is to evaluate the characteristics of unplanned transfers of adult patients from hospital wards to a neurological intensive care unit (NICU). We retrospectively reviewed consecutive unplanned transfers from hospital wards to the NICU at our institution over a 3-year period. In-hospital mortality rates were compared between patients readmitted to the NICU ("bounce-back transfers") and patients admitted to hospital wards from sources other than the NICU who were then transferred to the NICU ("incident transfers"). We also measured clinical characteristics of transfers, including source of admission and indication for transfer. A total of 446 unplanned transfers from hospital wards to the NICU occurred, of which 39 % were bounce-back transfers. The in-hospital mortality rate associated with all unplanned transfers to the NICU was 17 % and did not differ significantly between bounce-back transfers and incident transfers. Transfers to the NICU within 24 h of admission to a floor service accounted for 32 % of all transfers and were significantly more common for incident transfers than bounce-back transfers (39 vs. 21 %, p = .0002). Of patients admitted via the emergency department who had subsequent incident transfers to the NICU, 50 % were transferred within 24 h of admission. Unplanned transfers to an NICU were common and were associated with a high in-hospital mortality rate. Quality improvement projects should target the triage process and transitions of care to the hospital wards in order to decrease unplanned transfers of high-risk patients to the NICU.