Importance of early transfer to higher levels of in-patient care – an experience from a lower-middle-income country Authors Huzefa Jibril Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan Syed Ahsan Ali Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan Safia Awan Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan Muhammed Tariq Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan DOI: https://doi.org/10.47391/JPMA.10971 Keywords: critical illness, intensive care units, Emergency medical service Abstract Objective: To ascertain the frequency of hospitalised internal medicine patients requiring escalation to a higher level of care, and in-hospital mortality in such cases. Method: The prospective, observational study was conducted from September 1 to October 15, 2021 at a tertiary care hospital in Karachi, and comprised adult patients of either gender admitted to the internal medicine general wards and high dependency units. Data was collected prospectively using a proforma. Data was analysed using SPSS 23. Results: Of the 837 patients admitted, 617(73.7%) were included. There were 310(50.2%) females and 307(49.8%) males with mean age 52.2±18.8 years. The most common comorbidity was hypertension 288(46.7%). Of the 617 patients, 51(8.3%) required escalation to a higher level of care. Escalation to the intensive care unit and high dependency unit occurred in 19(37.3%) and 32(62.7%) patients, respectively. In-hospital mortality among patients who required escalation to the intensive care unit was 52.6%. In instances where the escalation was required within 48 hours of admission, in-hospital mortality was 8.3% (2/24), whereas, it was 40.7% (11/27) in cases when it was initiated beyond 48 hours of admission (p=0.010). The median length of hospital stay was also significantly lower when the escalation was initiated within 48 hours of admission 5 days (interquartile range: 4-7 days) compared to when it was delayed 13 days (interquartile range: 6-19 days) (p<0.001). The principal discharge diagnosis of sepsis was significantly associated with escalation to a higher level of care (p<0.001) and in-hospital mortality (p<0.001). Conclusions: Initiation of escalation to higher levels of care within 48 hours of admission was found to be associated with reduced in-hospital mortality and length of hospital stay. Key Words: Critical Illness, Intensive care units, Emergency medical service. Author Biography Huzefa Jibril, Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan Instructor, Department of Medicine Downloads Full Text Article Published 2025-01-26 How to Cite Jibril, H., Syed Ahsan Ali, Awan, S., & Tariq, M. (2025). Importance of early transfer to higher levels of in-patient care – an experience from a lower-middle-income country. Journal of the Pakistan Medical Association, 75(02), 192–196. https://doi.org/10.47391/JPMA.10971 More Citation Formats ACM ACS APA ABNT Chicago Harvard IEEE MLA Turabian Vancouver Download Citation Endnote/Zotero/Mendeley (RIS) BibTeX Issue Vol. 75 No. 02 (2025): FEBRUARY Section RESEARCH ARTICLE License Copyright (c) 2025 Journal of the Pakistan Medical Association This work is licensed under a Creative Commons Attribution 4.0 International License.