Clinical effectiveness of a critical care nursing outreach service in facilitating discharge from the intensive care unit.
BACKGROUND
Improved discharge planning and extension of care to the general care unit for patients transferring from intensive care may prevent readmission to the intensive care unit and prolonged hospital stays. Morbidity, mortality, and costs increase in readmitted intensive care patients.


OBJECTIVE
To evaluate the clinical effectiveness of a critical care nursing outreach service in facilitating discharge from the intensive care unit and providing follow-up in general care areas.


METHODS
A before-and-after study design (with historical controls and a 6-month prospective intervention) was used to ascertain differences in clinical outcomes, length of stay, and cost/benefit. Patients admitted to intensive care units in 3 adult teaching hospitals were recruited. The service centered on follow-up visits by specialist intensive care nurses who reviewed and assessed patients who were to be or had been discharged to general care areas from the intensive care unit. Those nurses also provided education and clinical support to staff in general care areas.


RESULTS
In total, 1435 patients were discharged during the 6-month prospective period. Length of stay from the time of admission to the intensive care unit to hospital discharge (P = .85), readmissions during the same hospital admission (5.6% vs 5.4%, P = .83), and hospital survival (P = .80) did not differ from before to after the intervention.


CONCLUSIONS
Although other studies have shown beneficial outcomes in Australia and the United Kingdom, we found no improvement in length of stay after admission to the intensive care unit, readmission rate, or hospital mortality after a critical care nursing outreach service was implemented.
Williams
Teresa Ann
TA
Critical Care Division at Royal Perth Hospital in Perth, Western Australia. Teresa.Williams@health.wa.gov.au
Leslie
Gavin
G
Finn
Judith
J
Brearley
Linda
L
Asthifa
Mariyam
M
Hay
Ben
B
Laurie
Karen
K
Leen
Tim
T
O'Brien
Keith
K
Stuart
Michael
M
Watt
Michelle
M
D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D003266:Continuity of Patient Care; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009732:Nursing Care / Q000379:methods*; D010351:Patient Discharge; D010359:Patient Readmission; D010360:Patient Transfer; D011446:Prospective Studies; D014904:Western Australia