A 24-Hour Postintensive Care Unit Transition-of-Care Model Shortens Hospital Stay

Abstract

A new model for the post-MICU transition of care, with the MICU team continuing to manage all patients transferred to the medical ward for at least 24 hours, significantly decreased duration of hospital stay after MICU transfer without affecting MICU readmission and mortality rate. The implementation of this model may lower medical costs and make transition of care safer without adverse outcomes.

Transition of care at discharge from the Intensive Care Unit: a scoping review

“…A qualitative study analyzing the perceptions of IU and ICU nurses on the benefits and challenges of the follow-up services of a post-intensive care group ( 30 ) identified favorable points for both, such as the provision of additional care to the most vulnerable patients and continuity of intensive care, through periodic visits by the ICU team, in addition to the exchange of knowledge between the groups of nurses, in which the IU team’s unpreparedness for more complex care was often identified. The impact of post-discharge follow-up programs was also quantitatively assessed, showing a decrease in hospital stay and in the ICU readmission rate ( 31 ) .…”

“…Readmission affects 4.1% ( 51 ) to 9.2% ( 46 ) of the patients in any period of hospitalization, 2.9% ( 14 ) in 48 hours after the transfer and 2.7% ( 32 ) to 4.2% ( 13 ) within 72 hours. Other clinical outcomes analyzed are length of hospital stay ( 31 - 32 , 35 , 39 - 40 , 49 ) , care provided by a Rapid Response Team (RRT) ( 26 , 43 ) , cardiac arrest ( 47 ) , and medications-related problems ( 49 ) . Outcomes such as anxiety, stress, and satisfaction of patients and families also appear in the studies ( 24 , 28 , 30 , 44 , 48 ) .…”

“…The follow-up or guidance after discharge by members of the intensive care team is one of the strategies with a potential positive impact on the patients’ outcomes, as evidenced by some studies, showing a decrease in the length of hospital stay ( 31 ) and in the ICU readmission rate ( 31 , 47 ) ; however, there was no consensus ( 13 - 14 ) . Corroborating these findings, a meta-analysis carried out in 2014 identified that transition of care programs focused on the follow-up after discharge from the intensive care were associated with reduced risk of readmission to the ICU ( 6 ) .…”

“…The readmission ( 13 - 14 , 20 , 26 , 31 - 32 , 34 - 35 , 43 , 46 - 47 , 49 - 52 ) and death ( 13 - 14 , 19 - 20 , 31 - 35 , 39 , 43 , 46 , 49 , 51 - 52 ) outcomes were more analyzed in the studies than other outcomes, with mortality rates showing a wide variation (3-30%) ( 19 , 46 ) . Few studies were devoted to assessing other adverse outcomes; however, it is important to note that not all patients undergoing an inadequate transition process evolve to death or readmission but, even so, they may be subjected to unwanted repercussions with serious consequences, such as the need to change or increase the length of treatment, increased length of hospital stay, disabilities, increased hospital costs, and dissatisfaction ( 9 ) .…”

“…Being monitored/advised by Intensive Care Unit professionals after discharge (13)(14)(24)(25)27,(30)(31)44,(46)(47) Positive Discharge planning and guidelines for patients/family (22)(23)(24)(28)(29)42,(44)(45)48) Positive Medication reconciliation/review by the pharmacist (14,22,(24)(25)(26)49) Positive…”