The Impact of Implementation of an ICU Consult Service on Hospital-Wide Outcomes and ICU-Specific Outcomes.
BACKGROUND
Rapid response teams (RRTs) were developed to promote assessment of and early intervention for clinically deteriorating hospitalized patients. Although the ideal composition of RRTs is not known, their implementation does require significant resources.


OBJECTIVE
To test the effectiveness of a dedicated daytime/weekday intensive care unit (ICU) consult service without formal training of ward teams.


METHODS
Pre- and postintervention study with weekends/nights during implementation period acting as a concurrent control.


METHODS
An adult tertiary care university center in Montreal without an RRT.


METHODS
A daytime/weekday ICU consult service with a dedicated intensivist.


RESULTS
Total hospital mortality rate did not differ between the control and the implementation period (6.65% vs 6.60%; P = .84). The hospital code blue rates also did not differ (1.21/1000 vs 1.14/1000 patient days; P = .58). In contrast, 30-day mortality of patients admitted to the ICU following an ICU consult decreased (39% vs 24% P = .01). Multivariate analysis confirmed this effect on 30-day mortality (odds ratio for implementation period: 0.53 [95% confidence interval: 0.33-0.85] P = .009). The 14-day ICU readmission rate was reduced with the intervention (5.1% vs 4.1%; P < .001). The effect on 30-day mortality and ICU readmissions were only present during daytime/weekdays.


CONCLUSIONS
Implementation of an ICU consult service without any formal afferent limb training was associated with decreased mortality and 14-day readmission rates of patients admitted to the ICU. In contrast, hospital-wide mortality and code blue rates were unaffected.
Critical Care Medicine Department, McGill University, Montreal, Quebec, Canada amjad.al-rajhi@mail.mcgill.ca.
Amjad
A
Al-Rajhi
Critical Care Medicine Department, McGill University, Montreal, Quebec, Canada.
Louay
L
Mardini
McGill University Health Centre and SMDB Jewish General Hospital, Montreal, Quebec, Canada.
Dev
D
Jayaraman
D000368:Aged; D016887:Cardiopulmonary Resuscitation / Q000706:statistics & numerical data*; D002985:Clinical Protocols; D003422:Critical Care / Q000458:organization & administration*; D005260:Female; D006323:Heart Arrest / Q000401:mortality* / Q000628:therapy*; D017052:Hospital Mortality; D057209:Hospital Rapid Response Team / Q000458:organization & administration; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration; D008297:Male; D012017:Referral and Consultation; D012189:Retrospective Studies; D062606:Tertiary Care Centers / Q000458:organization & administration
ICU consult service; delay; intensivist availability; medical emergency; rapid response teams; team