Missed Nursing Care in Intensive Care Patients Subjected to Interhospital Capacity Transfers: A Retrospective Matched Case–Control Chart Review

Abstract

Background The number of patients undergoing an interhospital intensive care unit-to-unit capacity transfer has dramatically increased. These transfers are complex, pose a risk for the patients and have been linked to increased intensive care unit length of stay and mortality, but the reasons for this are not known. We hypothesised that there was a difference in the incidence of missed nursing care among patients subjected to capacity transfer compared with patients not subjected to any transfer during their intensive care stay. Methods A retrospective case–control chart review was conducted on adult patients who between January 1, 2009, and January 31, 2020, underwent an interhospital intensive care unit-to-unit capacity transfer. We applied a matched control group by 1:2 matching. Missed nursing care was based on four variables: mobilisation, tooth brushing, oral care and nutrition. Data were retrieved from the local database and the patient’s medical charts at two general level 3 ICUs. Results The case group (n = 63) received significantly less mobilisation ( p < 0.05), mean 5.94 (2.36), compared with the control group (n = 126), mean 7.74 (2.96). In a subanalysis of the patients treated with invasive positive pressure ventilation and noninvasive positive pressure ventilation, the case group (n = 56) was found to receive significantly less oral care ( p < 0.05), median 3.50 (1.00–6.00), compared with the control group (n = 80), median 5.00 (2.00–7.75). None of the other variables were significantly related to interhospital intensive care unit-to-unit capacity transfers. Conclusion In critically ill patients, interhospital intensive care unit-to-unit capacity transfers were associated with missed nursing care. Future studies, focusing on capacity transfers should consider missed nursing care when the causes of increased intensive care unit length of stay and mortality are to be investigated.

Premature Discharge from Intensive Care with Special Reference to Night-Time Discharge and Capacity Transfers

“…There are studies suggesting that patients selected for capacity transfer will receive less care than the other patients in the unit. 83 There are some differences between transfer categories, and negotiation tends to be much more straightforward for clinical transfer, since it is a 'must-transfer' situation, whereas for capacity transfers or repatriations, the receiving hospital may be reluctant to accept the patient and may view the transfer as 'patient dumping'. 76 Studies show that accompanying personnel, together with mode of transport, were considered important by intensivists in determining transportability.…”