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Research Snapshot Theater: Pulmonary/Epidemiology - Outcomes, Adult

Immediate vs Late ICU Transfers for Respiratory Distress: Impact of Medical Emergency Team Follow-Up

Monday, March 23, 2026
11:30 AM - 12:30 PM Central Time
Location: Connections Central - RST 18
Introduction: Medical Emergency Teams (METs) are essential for stabilizing deteriorating ward patients, with outcomes influenced by ICU transfer timing. Immediate transfers (IT) involve the most critically ill. However, other seemingly stable patients may deteriorate within the following 48 hours (late transfers, LT)—a cohort with documented higher mortality, often due to unmonitored deterioration and delayed intervention. To address this, we implemented structured MET follow-up with 2/4/8-hour nursing assessments. This study compares IT and LT outcomes under this protocol.


Methods: We conducted a retrospective cohort study (Jan 2021 - Dec 2024) at a 510-bed tertiary hospital. Of 4,283 MET activations, 785 were for acute respiratory distress. Of these, 234 patients required ICU transfer and were included in the analysis (148 IT, 86 LT). Data collected included demographics, Charlson Comorbidity Index (CCI), APACHE II scores, and ICU interventions. Primary outcomes were ICU and in-hospital mortality; secondary outcomes included intubation and length of stay (LOS). Statistical analysis used t-tests, Mann–Whitney U, and chi-square tests, as appropriate (significance threshold: p < 0.05).


Results: IT and LT patients had similar characteristics, including age (61 vs. 59 years) and CCI scores (5.4 vs. 5.2), both p > 0.5. At MET activation, IT patients showed greater illness severity, with higher APACHE II scores (17.5 vs. 15), FiO₂ (0.63 vs. 0.53), and lower pH (7.36 vs. 7.41), all p < 0.01. They were transferred to ICU sooner (median 1 vs. 11 hours) and intubated earlier (median 1 vs. 20 hours), both p < 0.001. Among LT patients, 44% of transfers occurred during the 8-hour MET follow-up. After ICU admission, APACHE II scores (21.2 vs. 20.7), sepsis (49% vs. 53%), and intubation rates (53% vs. 60%) were similar between IT and LT groups, as were ICU mortality (37% vs. 30%) and in-hospital mortality (54% vs. 48%), all p > 0.28. ICU and hospital median LOS were also comparable (6 vs. 7 days and 25 vs. 30 days; both p > 0.05).


Conclusions: Although initially stable, a significant number of patients deteriorated following MET evaluation. MET follow-up may support early detection of clinical decline and help reduce risks associated with delayed ICU admission.