Does the implementation of a novel intensive care discharge risk score and nurse-led inpatient review tool improve outcome? A prospective cohort study in two intensive care units in the UK
Open accessAbstract
Objective: To develop a clinical prediction model for poor outcome after intensive care unit (ICU) discharge in a large observational data set and couple this to an acute post-ICU ward-based review tool (PIRT) to identify high-risk patients at the time of ICU discharge and improve their acute ward-based review and outcome. Design: Retrospective patient cohort of index ICU admissions between June 2006 and October 2011 receiving routine inpatient review. Prospective cohort between March 2012 and March 2013 underwent risk scoring (PIRT) which subsequently guided inpatient ward-based review. Setting: Two UK adult ICUs. Participants: 4212 eligible discharges from ICU in the retrospective development cohort and 1028 patients included in the prospective intervention cohort. Interventions: Multivariate analysis was performed to determine factors associated with poor outcome in the retrospective cohort and used to generate a discharge risk score. A discharge and daily ward-based review tool incorporating an adjusted risk score was introduced. The prospective cohort underwent risk scoring at ICU discharge and inpatient review using the PIRT. Outcomes: The primary outcome was the composite of death or readmission to ICU within 14 days of ICU discharge following the index ICU admission. Results: PIRT review was achieved for 67.3% of all eligible discharges and improved the targeting of acute post-ICU review to high-risk patients. The presence of ward-based PIRT review in the prospective cohort did not correlate with a reduction in poor outcome overall (P=0.876) or overall readmission but did reduce early readmission (within the first 48 hours) from 4.5% to 3.6% (P=0.039), while increasing the rate of late readmission (48 hours to 14 days) from 2.7% to 5.8% (P=0.046). Conclusion: PIRT facilitates the appropriate targeting of nurse-led inpatient review acutely after ICU discharge but does not reduce hospital mortality or overall readmission rates to ICU.
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The IDEAL-ICU trial did not report central venous access device infections, and the results for this outcome are unchanged from 2016.
“The IDEAL-ICU trial (507) did not report central venous access device (CVAD) infections: the results for this outcome are unchanged from 2016.”
From Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. (2021) · cites this paper as [507]
The Methods > Outcomes section (page unavailable) lists death and ICU readmission after discharge, not CVAD infections. Searches of our full-text copy for IDEAL-ICU, CVAD infections, and results unchanged from 2016 found no passage addressing the claim. This copy therefore cannot establish what the IDEAL-ICU trial reported. (LLM, conf=0.76)
Experimental — accuracy not yet measuredThe search identified a new RCT comparing early versus delayed renal replacement therapy.
“Our search identified a new RCT comparing early versus delayed RRT (507).”
From Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. (2021) · cites this paper as [507]
The Methods (Bias) describe a non-randomised ICU-discharge intervention, and the Results (Prospective cohort review) concern post-ICU readmission. Searches of our copy for early versus delayed renal replacement therapy and for renal replacement therapy found no passage about an RCT comparing those treatments. (LLM, conf=0.76)
Experimental — accuracy not yet measuredTransfer from ICU to general floor and hospital discharge are vulnerable periods with high frequency of medication errors and information loss.
“Transfer from ICU to general floor and discharge from the hospital are both vulnerable periods for patients, with high frequency of medication errors and information loss [596–602].”
From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [597]
Several studies, mostly before-and-after design, have examined critical care transition programmes on reducing ICU readmission or death among patients transferred from ICU to ward.
“Several studies, mostly before-and-after design, have examined the impact of critical care transition programmes on reducing ICU readmission or death among patients transferred from ICU to the ward [597, 601, 603–611].”
From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [597]
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- Authors
- Fabes, J., Seligman, W., Barrett, C., McKechnie, S., & Griffiths, J.
- Affiliations
- Department of Anaesthesia, University College London Hospitals NHS Foundation Trust, London, UK
- Chelsea and Westminster Hospital NHS Foundation Trust (GB)
- John Radcliffe Hospital (GB)
- Venue
- BMJ Open
- Publisher
- BMJ
- Published
- 2017-12
- Volume
- 7
- Issue
- 12
- Pages
- e018322
- ISSN
- 2044-6055 (ISSN-L)
- PMC
- PMC5770841
- OpenAlex
- W2779350486
- Cited by
- 9
- References
- 23
- Citations by year
- 2025: 1 · 2023: 1 · 2022: 2 · 2021: 3 · 2020: 2
- FWCI
- 0.43
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by-nc
- Locations
- BMJ Open (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- PEARL (University of Plymouth) (submittedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Funders
- University of Oxford
- Topics
- Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
- Health Sciences › Medicine › Emergency Medicine › Hospital Admissions and Outcomes
- Health Sciences › Health Professions › Emergency Medical Services › Patient Safety and Medication Errors
- Keywords
- intensive care unit discharge, clinical prediction model, ICU readmission, in-hospital mortality, early warning scores, high-risk patient identification, post-ICU care
- MeSH terms
- Adult, Aged, Female, United Kingdom, Humans, Intensive Care Units, Male, Middle Aged, Patient Discharge, Patient Readmission, Prospective Studies, Retrospective Studies, Risk Factors, ROC Curve, Severity of Illness Index, Multivariate Analysis, Logistic Models, Hospital Mortality, Nurse's Role, Young Adult
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