Objective: This study aimed to identify the proportion of patients who had clinical deterioration in the medical ward that required intensive care unit transfer and the factors associated with this transfer. Methods: A retrospective study of all patients admitted to the medical wards of King Abdulaziz University Hospital between 2010 and 2013 was performed. The demographics, admitting department, diagnosis at the time of admission to the ward, and cause of intensive care unit transfer were collected. Patients at risk for deterioration and early intensive care unit transfer were identified using physiologic threshold criteria. Results: A screening of 38,380 patients admitted to the various medical services during the study period was performed. Of these, 356 (0.9%) required intensive care unit transfer. Most patients were initially admitted from the emergency department (66.3%), while transfers from another hospital comprised approximately 1%. Intensive care unit transfer patients were more likely to have ischemic heart disease (P < 0.001), diabetes (P < 0.001), renal failure (P < 0.001), or sepsis associated with pressure ulcers (P < 0.001). They were also more likely to be bedridden (P < 0.001) or initially ventilated in the medical ward (P < 0.001). The mortality rate of the patients was 3.9% with patients who died being more likely to have unstable blood pressure at the time of admission (P = 0.026). Conclusion: This study identified several factors that were associated with intensive care unit transfer. Clinicians should consider these factors when determining patient disposition to ensure timely and appropriate management.