title: Clinical effectiveness of a critical care nursing outreach service in facilitating discharge from the intensive care unit.
abstract: 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.
authors.affiliation: Critical Care Division at Royal Perth Hospital in Perth, Western Australia. Teresa.Williams@health.wa.gov.au
authors.forename: Teresa Ann
authors.initials: TA
authors.lastname: Williams
authors.forename: Gavin
authors.initials: G
authors.lastname: Leslie
authors.forename: Judith
authors.initials: J
authors.lastname: Finn
authors.forename: Linda
authors.initials: L
authors.lastname: Brearley
authors.forename: Mariyam
authors.initials: M
authors.lastname: Asthifa
authors.forename: Ben
authors.initials: B
authors.lastname: Hay
authors.forename: Karen
authors.initials: K
authors.lastname: Laurie
authors.forename: Tim
authors.initials: T
authors.lastname: Leen
authors.forename: Keith
authors.initials: K
authors.lastname: O'Brien
authors.forename: Michael
authors.initials: M
authors.lastname: Stuart
authors.forename: Michelle
authors.initials: M
authors.lastname: Watt
mesh_terms: 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