Comparing the monitoring of patients transferred from a critical care unit to hospital wards at after‐hours with day transfers: an exploratory, prospective cohort study

Wood, Sally D; Coster, Samantha; Norman, Ian

doi:10.1111/jan.12410

Cited by 4 publications

(6 citation statements)

References 35 publications

(71 reference statements)

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“…The association between the transition of care practices and the patients’ outcomes has varied results when assessed in quantitative studies. Some studies verify the association of certain practices with readmission and mortality rates, such as discharges at nights or weekends ( 19 , 32 , 34 - 35 ) . Discharges with delays of more than 24 hours showed a significant association with a higher incidence of delirium ( 40 ) .…”

Section: Resultsmentioning

confidence: 99%

“…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 ) .…”

Section: Discussionmentioning

confidence: 99%

“…Discharge at night (11,21,24,(32)(33)(34)(35) , at shift changes (24) and on weekends (19,21) Negative…”

Section: Factors Related To the Intensive Care Unitmentioning

confidence: 99%

“…Lack of qualification and experience by the staff (11,25,28,30,(37)(38)42) Negative Reduced monitoring (11,14,34,37) Negative…”

Section: Factors Related To the Inpatient Unitmentioning

confidence: 99%

“…Readmission risk alert (43,50) Positive The outcomes and adverse events analyzed are mostly focused on readmission (13)(14)20,26,(31)(32)(34)(35)43,(46)(47)(49)(50)(51)(52) and on mortality after discharge from the ICU (13)(14)(19)(20)(31)(32)(33)(34)(35)39,43,46,49,(51)(52) . The mortality rate after discharge from the ICU varies from 3.0% (46) to 30% (19) according to the studies.…”

Section: Factors Related To the Intensive Care Unit And The Inpatient Unitmentioning

confidence: 99%

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

Hervé

Zucatti

Lima

2020

Rev. Latino-Am. Enfermagem

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Objective: to map the available evidence on the components of the transition of care, practices, strategies, and tools used in the discharge from the Intensive Care Unit (ICU) to the Inpatient Unit (IU) and its impact on the outcomes of adult patients. Method: a scoping review using search strategies in six relevant health databases. Results: 37 articles were included, in which 30 practices, strategies or tools were identified for organizing and executing the transfer process, with positive or negative impacts, related to factors intrinsic to the Intensive Care Unit and the Inpatient Unit and cross-sectional factors regarding the staff. The analysis of hospital readmission and mortality outcomes was prevalent in the included studies, in which trends and potential protective actions for a successful care transition are found; however, they still lack more robust evidence and consensus in the literature. Conclusion: transition of care components and practices were identified, in addition to factors intrinsic to the patient, associated with worse outcomes after discharge from the Intensive Care Unit. Discharges at night or on weekends were associated with increased rates of readmission and mortality; however, the association of other practices with the patient’s outcome is still inconclusive.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…Discharge at night (11,21,24,(32)(33)(34)(35) , at shift changes (24) and on weekends (19,21) Negative…”

Section: Factors Related To the Intensive Care Unitmentioning

confidence: 99%

“…Lack of qualification and experience by the staff (11,25,28,30,(37)(38)42) Negative Reduced monitoring (11,14,34,37) Negative…”

Section: Factors Related To the Inpatient Unitmentioning

confidence: 99%

Section: Factors Related To the Intensive Care Unit And The Inpatient Unitmentioning

confidence: 99%

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

Hervé

Zucatti

Lima

2020

Rev. Latino-Am. Enfermagem

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Emergent and Urgent Transfers to Neurosurgical Centers in Ontario

Merali¹,

Sharma²,

MacDonald³

et al. 2015

Prehospital Emergency Care

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Critically ill neurosurgical patients require expedient access to neurosurgical centers (NC) to improve outcome. In regionalized health systems patients are often initially evaluated at a non-neurosurgical center (NNC) and are subsequently transferred to a NC using air or ground vehicles. We sought to identify barriers to accessing a NC for critically ill patients by analyzing interfacility transfer times and referral patterns in the province of Ontario. A retrospective observational analysis was undertaken. The cohort included patients in Ontario with emergent and urgent neurologic pathologies who underwent transfer from a NNC to NC between January 1, 2011 and December 31, 2013. Timing, clinical, and geographic data were collected for each transfer. We identified 1103 emergent/urgent transfers. The median transfer time to a NC was 3.4 h (IQR -2.2, 3.8) and varied by the geographic region of origin. A total of 17% of the patients bypassed a closer NC during transfer to their destination NC. Transfers that bypassed a closer NC travelled further (101 miles vs. 296 miles, p < 0.001), took longer (3.1 h vs. 3.9 h, p < 0.001), and in some regions were associated with a higher risk of in-transit clinical decline (3.0% vs. 8.3%, p < 0.05) when compared with transfers that ended at the closest NC. Regionalization of neurosurgical services in Ontario has led to heavy reliance upon patient transfers to maintain continuity of care. Access to a NC varied across the province, which may represent regional differences in neurosurgical bed availability, resource limitations at smaller NCs, or environmental factors. Our descriptions of referral patterns and transport times can guide health system planning in Ontario and similar jurisdictions in the United States and Canada.

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Does the Time of Solitary Rapid Response Team Call Affect Patient Outcome?

Singh¹,

Vegunta²,

Karpe³

et al. 2019

Indian Journal of Critical Care Medicine

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Objective: The study aimed to evaluate the effect of a single after-hours rapid response team (RRT) calls on patient outcome. Design: A retrospective cohort study of RRT-call data over a 3-year period. Setting: A 600-bedded, tertiary referral, public university hospital. Participants: All adult patients who had a single RRT-call during their hospital stay. Intervention: None. Main outcomes measures: The primary outcome was to compare all-cause in-hospital mortality. The secondary outcomes were to study the hourly variation of RRT-calls and the mortality rate. Results: Of the total 5,108 RRT-calls recorded, 1,916 patients had a single RRT-call. Eight hundred and sixty-one RRT-calls occurred during workhours (08:00-17:59 hours) and 1,055 during after-hours (18:00-7:59). The all-cause in-hospital mortality was higher (15.07% vs 9.75%, OR 1.64, 95% CI 1.24-2.17, p value 0.001) in patients who had an after-hours RRT-call. This difference remained statistically significant after multivariate regression analysis (OR 1.50, 95% CI 1.11-2.01, p value 0.001). We noted a lower frequency of hourly RRT-calls after-hours but were associated with higher hourly mortality rates. There was no difference in outcomes for patients who were admitted to ICU post-RRT-call. Conclusion:Patients having an after-hour RRT-call appear to have a higher risk for hospital mortality. No causal mechanism could be identified other than a decrease in hourly RRT usage during after-hours.

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Comparing the monitoring of patients transferred from a critical care unit to hospital wards at after‐hours with day transfers: an exploratory, prospective cohort study

Abstract: Surveillance differences, including time to the first set of observations and frequency of observations in the first 12 hours, are potential factors that may explain the differential mortality associated with after-hours transfers.

Cited by 4 publications

References 35 publications

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

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

Emergent and Urgent Transfers to Neurosurgical Centers in Ontario

Does the Time of Solitary Rapid Response Team Call Affect Patient Outcome?

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