Psychological Outcomes in Family Members of Acute Respiratory Failure Patients: Does Inter-ICU Transfer Play a Role?

BACKGROUND: Family members of ICU patients experience a constellation of sequelae described as post-intensive care syndrome-family. The influence that an inter-ICU transfer has on psychological outcomes is unknown.

RESEARCH QUESTION: Is inter-ICU transfer associated with poor psychological outcomes in families of Acute Respiratory Failure (ARF) patients?

STUDY DESIGN: and Methods- Cross-sectional observational study of 82 families of patients admitted to adult ICUs (tertiary hospital). Data included demographics, admission source and outcomes. Admission source was classified as 'inter-ICU transfer'(N=39) for patients admitted to the ICU from other hospitals, and 'direct admit' (N=43) for patients admitted from the emergency room or the operating room of the same hospital. We used quantitative surveys to evaluate psychological distress (Hospital Anxiety and Depression Scale; HADS) and post-traumatic stress (Post-Traumatic Stress Scale; PTSS) and examined clinical, family, and satisfaction factors associated with psychological outcomes.

RESULTS: Transferred families travelled longer distances (M = 109 miles, SD = 106) compared to direct admits (M = 65 miles, SD = 156) (p=<0.0001). Transferred patients were predominantly admitted to the neuro ICU (64%), had longer length of stay (direct admits M = 12.7 days, SD = 9.3; transferred M = 17.6 days, SD = 9.3; p<0.01) and higher ventilator days (direct admits M = 6.9, SD = 8.6; transferred M = 10.6 SD = 9.0; p<0.01). Additionally, they were less likely to be discharged home (direct admits 63%; transferred 33% p=0.08). In a fully adjusted model of psychological distress and post-traumatic stress, family members of transferred patients were found to have a 1.74 point (95% CI -1.08, 5.29; p=0.30) higher HADS score and a 5.19 point (95% CI 0.35, 10.03, p=0.03) higher PTSS score than those of directly admitted family members.

INTERPRETATION-: In this exploratory study, post-traumatic stress measured by PTSS was higher in the transferred families, but these findings will need to be replicated to infer clinical significance.