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Intensive Care Medicine

, Volume 42, Issue 3, pp 401–410 | Cite as

Critical care transition programs and the risk of readmission or death after discharge from ICU

  • Henry T. StelfoxEmail author
  • Jaime Bastos
  • Daniel J. Niven
  • Sean M. Bagshaw
  • T. C. Turin
  • Song Gao
Original

Abstract

Purpose

Critical care transition programs have been widely implemented to improve the safety of patient discharge from ICU, but have undergone limited evaluation. We sought to evaluate implementation of a critical care transition program on patient readmission to ICU (72 h) and mortality (14 days).

Methods

Interrupted time series analysis of 32,234 consecutive adult patients discharged alive from medical-surgical ICUs in eight hospitals in two cities between January 1, 2002 and January 1, 2012. A multidisciplinary ICU provider team (physician, nurse, respiratory therapist) that serially evaluated each patient after ICU discharge was implemented in three hospitals in one city (study group), but not the five hospitals in the other city (control group). Temporal changes were examined using multivariable, segmented linear regression models.

Results

After implementation of the program, there was an immediate non-significant decrease in the absolute proportion of patients readmitted to ICU in the study group (−0.4 %, 95 % CI −1.7 to +1.0 %) and a non-significant increase in the absolute proportion of patients readmitted to ICU in the control group (+1.0 %, 95 % CI −0.3 to +2.2 %). Subsequently, there were non-significant changes in the absolute proportion of patients readmitted to ICU in both the study (+0.1 % per quarter; 95 % CI, −0.1 to +0.2 %) and control (−0.1 per quarter; 95 % CI, −0.2 to +0.1 %) groups over time. No significant changes were observed in mortality. The results were stable across patient subgroups.

Conclusions

Implementation of a critical care transition program was not associated with patient readmission to ICU or mortality.

Keywords

Intensive care unit Patient discharge Mortality Readmission Patient handoff 

Notes

Acknowledgments

The study was funded by an establishment grant from Alberta Innovates—Health Solutions (20,100,368). HTS is supported by a Population Health Investigator Award from Alberta Innovates—Health Solutions. DJN is supported by a Clinician Fellowship Award from Alberta Innovates—Health Solutions, and a Knowledge Translation Canada Student Fellowship and Training Program grant. SMB is supported by a Canada Research Chair in Critical Care Nephrology and Clinical Investigator Award from Alberta Innovates—Health Solutions. Funding sources had no role in the design, conduct, or reporting of this study and we are unaware of any conflicts of interest. Dr Stelfox and Mr Gao had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Compliance with ethical standards

Conflicts of interest

Funding sources had no role in the design, conduct, or reporting of this study and we are unaware of any conflicts of interest.

Supplementary material

134_2015_4173_MOESM1_ESM.docx (98 kb)
Supplementary material 1 (DOCX 97 kb)

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Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2015

Authors and Affiliations

  • Henry T. Stelfox
    • 1
    Email author
  • Jaime Bastos
    • 1
  • Daniel J. Niven
    • 1
  • Sean M. Bagshaw
    • 2
  • T. C. Turin
    • 3
  • Song Gao
    • 4
  1. 1.Departments of Critical Care Medicine, and Community Health SciencesUniversity of Calgary and Alberta Health ServicesCalgaryCanada
  2. 2.Division of Critical Care Medicine, Faculty of Medicine and DentistryUniversity of Alberta and Alberta Health ServicesEdmontonCanada
  3. 3.Department of Family MedicineUniversity of Calgary and Alberta Health ServicesCalgaryCanada
  4. 4.Alberta Health ServicesCalgaryCanada

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