Hospital ward transitions and outcomes in critical care survivors: A multi-hospital cohort study.

Background: Hospital ward transitions remain poorly understood despite their importance to patient flow and efficiency. Transition patterns are shaped by local policy and pathways, but in critically ill patients, transitions may also accumulate in response to clinical complexity. This study aimed to characterise patterns of ward transitions, identify determinants of ward transition frequency, and evaluate associations with adverse patient outcomes. Methods: This retrospective cohort study comprised patients admitted through the emergency department (ED) across three acute hospitals in a region of Scotland between 2017 and 2022 who experienced a critical care admission prior to hospital discharge. Ward transition patterns were characterised using descriptive statistics and frequency distributions. Regression analyses were conducted to identify factors associated with transition frequency and to examine associations with 7-day ED reattendance, 30-day emergency hospital readmission, 30-day post-discharge mortality, and hospital length of stay. Results: 12,836 critical care survivors were included. In univariable analyses, factors including age, comorbidity burden, smoking status, deprivation, and level of organ support were associated with transition frequency. Greater transition burden was associated with increased odds of 7-day ED reattendance (adjusted OR = 1.12, 99.89% CI: 1.07-1.17) and prolonged length of stay (adjusted beta coefficient 1.35, 99.89% CI: 1.34-1.36), but not 30-day readmission (adjusted OR = 1.01, 99.89% CI: 0.96-1.05) or 30-day mortality (adjusted OR = 0.99, 99.89% CI: 0.86-1.14). Conclusion: Increased ward transitions in critically ill patients mark clinical complexity. It is associated with longer hospital stays and may help identify those at greater risk of early ED reattendance.