The First 48 Hours: Incidence, Timing and Predictors of Adverse Events After ICU-To-Ward Transfer: A Prospective Cohort Study.

BACKGROUND

The transition from the intensive care unit (ICU) to a general ward is a period of heightened vulnerability, yet the precise timing and modifiable predictors of adverse events remain poorly defined.

AIMS: To determine the incidence, timing and types of adverse events following ICU-to-ward transfer, evaluate the predictive accuracy of four early-warning scores and identify independent risk factors.

STUDY

DESIGN

A prospective cohort study of 207 adult patients transferred from ICUs to general wards at a tertiary university hospital over 20 months (March 2024-October 2025) was enrolled. Four early warning scores (PACS, MEWS, SWIFT, LACE) were calculated daily for 5 days post-transfer. Multivariable logistic regression was used to identify independent risk factors.

RESULTS

The total number Adverse events occurred in 52 patients (25.1%), most commonly ICU readmission (n = 46, 22.2%) and healthcare-associated infections (n = 29, 14.0%). Critically, 88% of events occurred within the first 48 h (day 1: 56.0%; day 2: 32.0%). SWIFT demonstrated the highest predictive accuracy at transfer (AUC 0.856). Mechanical ventilation was the strongest independent risk factor (OR 10.11), followed by prolonged ICU stay (OR 6.40), respiratory diagnosis (OR 4.99), > 3 invasive devices (OR 4.41) and comorbidities (OR 3.64). These five factors collectively explained 88.5% of adverse events.

CONCLUSION

Adverse events affect one in four patients after ICU-to-ward transfer, with the vast majority occurring within the first 48 h. A simple set of readily identifiable risk factors can guide nursing surveillance and targeted interventions during this critical window.

RELEVANCE TO CLINICAL PRACTICE: Bedside nurses should prioritize enhanced monitoring for patients with a history of mechanical ventilation, prolonged ICU stay, multiple invasive devices and significant comorbidities during the first 48 h post-transfer. Daily use of early-warning scores can inform monitoring frequency and rapid response activation.