title: Critical care transition programs and the risk of readmission or death after discharge from ICU.
abstract: OBJECTIVE
  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.
authors.affiliation: Departments of Critical Care Medicine, and Community Health Sciences, University of Calgary and Alberta Health Services, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada. tstelfox@ucalgary.ca.
authors.forename: Henry T
authors.initials: HT
authors.lastname: Stelfox
authors.affiliation: Departments of Critical Care Medicine, and Community Health Sciences, University of Calgary and Alberta Health Services, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada.
authors.forename: Jaime
authors.initials: J
authors.lastname: Bastos
authors.affiliation: Departments of Critical Care Medicine, and Community Health Sciences, University of Calgary and Alberta Health Services, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Niven
authors.affiliation: Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta and Alberta Health Services, Edmonton, Canada.
authors.forename: Sean M
authors.initials: SM
authors.lastname: Bagshaw
authors.affiliation: Department of Family Medicine, University of Calgary and Alberta Health Services, Calgary, Canada.
authors.forename: T C
authors.initials: TC
authors.lastname: Turin
authors.affiliation: Alberta Health Services, Calgary, Canada.
authors.forename: Song
authors.initials: S
authors.lastname: Gao
mesh_terms: D000368:Aged; D000416:Alberta; D003266:Continuity of Patient Care / Q000458:organization & administration*; D003422:Critical Care / Q000458:organization & administration*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D065186:Interrupted Time Series Analysis; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D010351:Patient Discharge; D010359:Patient Readmission / Q000706:statistics & numerical data*
keywords: Intensive care unit; Mortality; Patient discharge; Patient handoff; Readmission