Unplanned ICU Transfers from Inpatient Units: Examining the Prevalence and Preventability of Adverse Events Associated with ICU Transfer in Pediatrics

Background Adverse events have been associated with unplanned intensive care unit (ICU) transfers in adults. Objective To examine trends in unplanned ICU transfers in pediatrics resulting from adverse events. Design, Setting, Patients Retrospective observational study of pediatric and cardiac ICU transfers from acute care units during a 2-year period in a tertiary care children's hospital. Methods Transfers were identified via electronic health record query and investigated for adverse events. Predefined adverse events included ICU transfers within 12 hours of admission to an acute care unit, readmissions to an ICU within 24 hours, and cardiopulmonary arrest on an acute care unit. Other adverse events examined were not predefined. Adverse events were evaluated for preventability and categorized by type, diagnosis, time of day and weekday versus weekend occurrence, and level of associated patient harm. Results There were 1,008 ICU transfers during the study period; 67% were unplanned. Of the unplanned transfers, 32% were attributed to adverse events, 35% of which were preventable. Unplanned transfers associated with a high rate of preventable adverse events included readmission to an ICU within 24 hours (58%, p = 0.002) and ICU transfer within 12 hours of acute care admission (34%). Conclusions We observed a high rate of preventable adverse events associated with unplanned pediatric ICU transfers, many of which were due to inappropriate triage. Readmission to an ICU within 24 hours of transfer to an acute care unit was significantly associated with preventability.