Time of transfer from critical care

Published Date: 19th July 2016

Publication Authors: McCairn AJ, Wood J, Jones C

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INTRODUCTION

Night time transfer from critical care to the general wards is associated with increased hospital mortality and transfer from critical care areas to the general ward between 22:00 and 07:00 should be avoided whenever possible1. In addition the timing of transferring a patient from the critical care unit to the general ward may have psychological effects and exacerbate patients' anxiety2. It was hypothesised that day time (07:00 to 21:59) transfers are less anxiety provoking for patients than night time transfers (22:00 to 06:59).

OBJECTIVES

To examine the impact of transfer time on patient anxiety.

METHODS

A pragmatic prospective cohort study of critically ill patients over the age of 16 years was undertaken in a 14 bed adult critical care unit in a National Health Service (NHS) teaching hospital trust in the United Kingdom. Included criterion was critically ill patients staying on the critical care unit for at least 24 hours and clinically ready for transfer to the general ward within the same hospital setting. Study participants completed the Hospital Anxiety and Depression Scale (HADS) questionnaire3. The HADS questionnaire was completed at: pre-transfer - on the critical care (when they were clinically ready for transfer to the general ward), post-transfer - on the general ward therefore capturing the transfer process.

RESULTS

47 patients were included, 1 patient did not complete the pre-transfer HADS but went on to complete the post-transfer HADS and 3 patients were discharged from hospital before completion of the post-transfer HADS. The post-transfer incidence of cases for the anxiety sub-group of the HADS was 22% (8/36) for day time and 64% (7/11) for night time; this was found to be statistically significant using the Kruskal Wallis Test, H = 7.26, p = 0.007. The post-transfer median score for the anxiety sub-group of the HADS was 6 (CI 5.7 - 8.6) for day time and 12.5 (CI 8.3 - 15.7) for night time; this was found to be statistically significant using the Kruskal Wallis Test, H = 6.40, p = 0.011.

CONCLUSIONS

This pragmatic prospective cohort study suggests that transfers at night time are more anxiety provoking for patients than transfers in the day time.

McCairn, AJ; Jones, C; Wood, J. (2013).  Does time of transfer from critical care to general wards affect anxiety? (tracing anxiety) . Intensive Care Medicine. 39 (Issue 2 Supple), S402

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