Association between emergency department-to-intensive care unit transfer time and mortality in patients with septic shock: a target trial emulation with septic shock in South Korea.

Summary

In a multicenter target-trial emulation of 815 septic shock patients, ICU transfer within 3 hours was associated with lower in-hospital mortality, with risk increasing up to 6 hours and then plateauing. Benefits were strongest among patients needing ECMO or CRRT, underscoring the value of system-level strategies to reduce ED boarding.

Key Findings

• Median ED-to-ICU transfer time was 6.7 hours; only 7% transferred within 3 hours.
• ICU transfer within 3 hours was associated with lower in-hospital mortality (OR 0.48, 95% CI 0.24-0.94).
• Mortality risk increased with transfer delay up to 6 hours and then plateaued; benefits were most pronounced in patients needing ECMO or CRRT (interaction P=0.02).

Clinical Implications

Prioritize ICU transfer within 3 hours for septic shock, especially for patients likely to require ECMO/CRRT; implement operational metrics and early warning systems to reduce boarding delays.

Limitations

• Observational design with potential residual confounding and regional practice patterns (South Korea).
• Only a small proportion (7%) achieved transfer within 3 hours, which may affect precision.

Future Directions

Prospective implementation trials to test system changes reducing boarding; integration with early warning scores and resource triage; external validation across diverse health systems.