Impact of an Outreach team on re‐admissions to a critical care unit

Abstract

Summary Re‐admissions have been cited as a measure of critical care quality and outreach teams have recently been introduced to improve critical care delivery. The aim of this study was to examine whether the number, causes and sequence of re‐admissions to critical care altered as a result of the introduction of an outreach team. Re‐admissions between April 2000 and November 2001 were examined. The reasons for re‐admission were classified as (i) same pathology or disease process; (ii) new, but related, pathology; (iii) new and unrelated pathology; (iv) exacerbation of other comorbidities. During the two‐year period, a total of 2546 patients were admitted to critical care of which 100 were re‐admitted (49 before outreach and 51 after outreach). The reasons for re‐admission did not vary before or after the introduction of the outreach team (same pathology 15 vs. 15; new, but related, pathology 17 vs. 23; new, but unrelated, 14 vs. 9; exacerbation of comorbidity 3 vs. 4, respectively, Chi‐squared = 2.07, df = 3, p = 0.56). There was also no difference between the duration of stay on the general ward in between the critical care unit admissions before (median 2.93 [interquartile range 1.32–6.05] days) or after (median 2.25 [interquartile range 1.06–6.32] days) the introduction of an outreach team. As we could not detect any change in patterns of re‐admissions as a result of the introduction of an outreach team, we would suggest that although outreach is an important development for critical care, its performance should be measured by other parameters.

Effect of the critical care outreach team on patient survival to discharge from hospital and readmission to critical care: non-randomised population based study

“…A recent study could detect no change in patterns of readmission after the introduction of a critical care outreach team 16. It is difficult to extrapolate from the report if the operational policy was similar to that described in our study, and although the setting seems similar, a far larger sample was examined.…”

“…Our small sample size increased the risk of a type 2 error, which is much smaller than those used to test the effectiveness of medical emergency teams or the effect on readmission rates 8 9 16. If the innovation described here had not been introduced so hastily, owing to political imperative, we could have conducted a prospective randomised controlled trial.…”

Early and innovative interventions for severe sepsis and septic shock: taking advantage of a window of opportunity

“…88 Current Canadian guidelines are evolving for triage and the use of acuity scales; future adjustments will be required to better detect sepsis in its early stages. 89 From a therapeutic perspective, 90 Hillman 91 and others [92][93][94][95][96][97][98][99][100][101][102] examined the effects of an in-hospital medical emergency team using early identifiers of the high-risk patient. These teams of intensive-care nurses and physicians were mobilized when specified alterations in airway, breathing, circulation and neurologic status were met.…”

Role of Transitional Care Measures in the Prevention of Readmission After Critical Illness

“…50,56 Most critical care outreach models use patient mortality, critical care readmission rates from the general care area, length of stay, and patient/caregiver satisfaction as measurements of effectiveness. 1,[48][49][50][51][52][53]56,57 Collectively, studies have demonstrated that patients experienced improved outcomes after implementation of a critical care outreach program; following implementation, patients experienced decreased risk of readmission to the critical care unit 49 and/or shorter stays after readmission. 49,50,52,54,56 In contrast, several studies 51,53,56,58 did not show statistically significant alterations in readmission rates, hospital length of stay, patient anxiety, or hospital survival after implementation of outreach services.…”