Delayed Admission to the Intensive Care Unit Is Associated With Increased Mortality Risk in Critically Ill Patients: A Prospective Cohort Study

AIM: To examine the impact of delays in intensive care unit (ICU) admission on patient outcomes, specifically clinical deterioration and mortality among patients transferred from the emergency department (ED) or general wards following acute deterioration in an Australian public hospital. DESIGN & METHODS: This prospective cohort study was conducted over a 12-month period (15 April 2022-14 April 2023) in a 209-bed regional hospital. It included adult patients (aged ≥ 18 years) admitted to the ICU from ED or general wards following acute deterioration. Primary outcomes measured were duration of delay in ICU admission, ICU and hospital mortality and changes in Sequential Organ Failure Assessment (SOFA) scores over time to assess organ dysfunction and progression. RESULTS: A total of 403 patients were included. Of these, 276 (68.5%) experienced delays in ICU admission, ranging from 25 min to 347.25 h (median: 7.13 h). Delayed ICU admission was associated with increased mortality. Each one-point increase in the highest recorded SOFA score was linked to a 7.5% rise in mortality odds, while each one-point increase in the initial or 24-h SOFA score corresponded to a 6.8% increase. CONCLUSIONS: Delayed ICU admission was significantly associated with increased mortality, particularly in patients with elevated SOFA scores, indicating worsening organ dysfunction and clinical instability. IMPLICATIONS FOR PRACTICE: These findings highlight the urgent need for improved triage systems, early warning protocols and streamlined escalation pathways to expedite ICU transfers for deteriorating patients. Timely intervention is essential to reduce harm and improve outcomes. IMPACT: This study reinforces the clinical risks of delayed ICU admission and supports timely escalation of care in emergency and ward settings across Australian public hospitals. REPORTING: Conducted in accordance with STROBE guidelines. PATIENT/PUBLIC CONTRIBUTION: No direct patient or public involvement. The study used routinely collected clinical data to evaluate systemic and clinical outcomes.