Older patients, those with fewer comorbidities (lower CCI), with low oxygen saturation Enzastaurin side effects (<98%) and those who were intubated at the ED were also more likely

to stay for two or more days in the MICU/HDU. All patients excluding those admitted to the ICU for hypotension, respiratory failure or who were intubated In-hospital mortality: Of the 706 patients in the study, only 197 remained in the analysis after excluding patients with hypotension, respiratory failure or who were intubated. None of the factors tested, including direct/indirect admission, were significantly associated with in-hospital mortality (table 4(1)). Table 4 Adjusted results for the effect of indirect MICU/HDU admissions on selected outcomes (all patients excluding those admitted to the ICU for hypotension, respiratory failure or who were intubated) Death within 60 days of admission: With 197 patients included in the analysis, none of the factors included in the logistic regression model were significantly associated with mortality within 60 days of admission (table 4(2)). Total in-hospital

length of stay: After further excluding patients who died during hospitalisation, 178 patients remained in the analysis. Using Cox proportional hazards, lower CCI was the only variable associated with total in-hospital length of stay (table 4(3)). There was no significant difference in the total in-hospital length of stay for direct and indirect MICU/HDU admissions. MICU/HDU length of stay: As with total in-hospital length of stay, patients who died during hospitalisation were excluded from the analysis. Results of Cox proportional hazards show that none of the factors, including direct/indirect admission, were significantly associated with MICU/HDU length of stay (table 4(4)). Discussion In this study, one-third of patients were indirectly admitted to

the MICU/HDU. A multicentre study in the USA and Europe on patients with pneumonia revealed a similar indirect admission rate of 30.5%.16 A Brazilian study reported that 68.8% of admissions to the ICU were delayed as a result of indirect admissions to the ward,17 while a study from the UK found that 17.6% of ICU admissions were indirect transfers.18 However, GSK-3 the wide disparity in figures across settings may be related to the lack of a standard definition for indirect admission or admission delays. Of the various independent variables considered in this study, indirect admission to intensive care was identified as one of the few which were independently associated with in-hospital mortality, death within 60 days of admission, and length of stay at the MICU/HDU. Other researchers had similar findings suggesting poor outcomes for patients indirectly admitted or whose admission was delayed.8 11 12 14–17 19–24 Establishing the magnitude of the problem as well as its consequences is an important first step towards planning for improvements.