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

Shivaprasad Anagi; Diane Chamberlain; Nigel Barr; Ahmed Mehdi; William Pinzon Perez; Raju Pusapati; Daryl Taypin Shaw; Christine Jennings; Frances Lin

doi:10.1111/jan.70493

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

Journal article

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

Shivaprasad Anagi, Diane Chamberlain, Nigel Barr, Ahmed Mehdi, William Pinzon Perez, Raju Pusapati, Daryl Taypin Shaw, Christine Jennings and Frances Lin

Journal of Advanced Nursing, Vol.82(9), pp.8646-8657

2026

DOI: https://doi.org/10.1111/jan.70493

PMCID: PMC13460959

PMID: 41825944

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Abstract

hospital mortality

intensive care units

patient admission

patient flow

time-to-treatment

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.

Details

Title: Delayed Admission to the Intensive Care Unit Is Associated With Increased Mortality Risk in Critically Ill Patients: A Prospective Cohort Study
Authors: Shivaprasad Anagi (Corresponding Author) - Metro North Health (Australia)
Diane Chamberlain - Flinders University
Nigel Barr - University of the Sunshine Coast
Ahmed Mehdi - The University of Queensland
William Pinzon Perez - QCIF Ltd.
Raju Pusapati - Hervey Bay Hospital (Australia)
Daryl Taypin Shaw - Hervey Bay Hospital (Australia)
Christine Jennings - Hervey Bay Hospital (Australia)
Frances Lin - University of the Sunshine Coast
Publication details: Journal of Advanced Nursing, Vol.82(9), pp.8646-8657
Publisher: Wiley-Blackwell Publishing Ltd.
Date published: 2026
DOI: 10.1111/jan.70493
ISSN: 1365-2648
PMID: 41825944; PMC13460959
Copyright note: © 2026 The Author(s). Journal of Advanced Nursing published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
Data Availability: The data that support the findings of this study are available from the corresponding author upon reasonable request.
Grant note: The project is funded by Queensland Health's Clinical Research Fellowship Novice Researcher grant (Rural, Regional & Remote category-2024).
Organisation Unit: School of Health; School of Health - Paramedicine
Language: English
Record Identifier: 991217259802621
Output Type: Journal article

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