Impact of a Critical Care Response Team on Night Time Discharges from the Intensive Care Unit
CCCF ePoster library. Basmaji J. Oct 26, 2015; 114768; P45
John Basmaji
John Basmaji
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Abstract
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P45


Topic: Retrospective or Prospective Cohort Study


Impact of a Critical Care Response Team on Night Time Discharges from the Intensive Care Unit



John Basmaji, W. Chehadi, F. Priestap, C. Martin, R. Kao

Department of Medicine, Western University, Schulich School of Medicine and Dentistry, London, Canada | Critical Care Medicine, St. Thomas Elgin General Hospital, Huron Perth Health Care Alliance, St. Thomas, Canada | Critical Care Medicine, Western University, Schulich School of Medicine and Dentistry, London, Canada | Critical Care Medicine, London Health Sciences Center, London, Canada | Critical Care Medicine, London Health Sciences Center, London, Canada

Introduction: Transfers from the Intensive Care Units (ICUs) that occur after normal working hours have been associated with an increase in ICU readmission, morbidity, and mortality; however studies demonstrating this were performed prior to the implementation of Critical Care Response Teams (CCRTs), who follow patients after ICU transfer on the wards to address critical care concerns.

Objectives: We investigated whether ICU admissions, morbidity, and mortality in association with nighttime discharges were reduced as a result of CCRTs.

Methods: A retrospective chart review identified 1154 transfers from the Critical Care Trauma Center (CCTC) at London Health Science Center (LHSC) from January 2011 to December 2012. Transfers were stratified based on whether they occurred during working hours (daytime) or after working hours (nighttime).

Results: Nighttime transfers were found to have a slightly higher multiple organ dysfunction score (4.8 ± 3.0 vs 5.2 ± 3.1, p = 0.05). Nighttime transfers were more likely to have decreased urine output (0.53% vs 0.88%, p = 0.006). There were no statistically significant differences in interventions by CCRT between daytime and nighttime discharges. No statistically significant difference was found in CCTC re-admission rates and mortality in the post-ICU transfer CCRT follow-up period, but overall in-hospital mortality was higher in nighttime transfers (OR 2.67, 95% confidence interval, 1.39 – 5.22, p = 0.001).

Conclusion: Although total in-hospital mortality for nighttime transfers remained higher, these results suggest that the implementation of CCRTs have decreased ICU readmissions and mortality in the post-ICU transfer followup period associated with nighttime transfers.



References: Priestap, Fran A. MSc, Martin, Claudio M. MD, FRCPC. Impact of intensive care unit discharge time on patient outcome. Crit Care Med. 2006;34(12):2946-51.
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