Newswise — After being transferred out of an intensive care unit (ICU) and before their discharge from the hospital, ICU survivors remain at high risk for poor short-term outcomes.
Little is known about the complex needs of these patients during the vulnerable time referred to as early ICU aftercare, even though they often spend most of their hospital stay in an acute medical care unit after they are transferred out of the ICU.
“Bridging the Gap Between the Intensive Care Unit and the Acute Medical Care Unit” analyzes patient and clinical factors associated with poor short-term hospital outcomes for ICU survivors before they are discharged from the hospital. One of the first studies to characterize early ICU aftercare, the article is published in American Journal of Critical Care.
Researchers from the Institute of Health System Science at The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, conducted the study to improve the quality of care of hospitalized adults. Co-author Liron Sinvani, MD, is a hospitalist with geriatrics training and an associate professor at the Feinstein Institutes.
“Even after patients leave the ICU for an acute medical care unit, they often continue to have complex conditions that require specialized care during this vulnerable time,” Sinvani said. “Our findings highlight the urgent need to understand and address the unmet needs of ICU survivors in early ICU aftercare.”
The retrospective cohort study examined electronic health record data from patients who were admitted from the emergency department directly to the medical ICU and subsequently transferred to the acute medical care unit. The study included patients from two Northwell Health hospitals in the New York metropolitan area, over a 12-month period (Jan. 1 to Dec. 31, 2017). A total of 151 of 400 randomly selected adult patients met the inclusion criteria.
The mean length of stay in the hospital among the patients was 13.3 days, with a mean of 4.1 days in the ICU. Following ICU transfer, 6.6% required readmission to the ICU, 4.6% died during their hospitalization, and 18.5% were readmitted to the hospital within 30 days of discharge.
The most frequent ICU admitting diagnoses were sepsis and respiratory failure, and nearly half of the patients had required either intravenous pressor support and/or mechanical ventilation while in the ICU.
Most ICU survivors did not have documentation of advance directives or goals of care, which are essential discussions to help ensure the patient’s prognosis, priorities and wishes are known to their family and to the care team.
The study found that ICU survivors often experience delirium, functional decline and difficulty swallowing during early ICU aftercare, yet orders for bed rest and dietary restrictions were common. Improved recognition and management of these conditions would help reduce adverse effects and improve quality of life after discharge, according to the study.
A quarter of patients were transferred to the acute medical care unit with a newly placed bladder catheter, which was a significant predictor of ICU readmission.
The use of high-risk medications was also common in early ICU aftercare. Nearly a quarter of ICU survivors received opiates to address pain; however, less than 60% of those patients had a concurrent order for acetaminophen, which could reduce opiate use and adverse events. The use of midodrine was associated with increased in-hospital mortality, and post-ICU clinicians should be on alert for patients who had received the medication as part of their ICU stay.
The hospitals studied did not have progressive care or stepdown units, and all ICU patients are transferred to acute medical care units throughout the facilities. These units have average nurse-to-patient ratios between six to eight patients per nurse.
The researchers call for future studies to address early ICU aftercare, as well as new initiatives to engage non-critical care providers beyond the ICU to further improve patient outcomes.
To access the article and full-text PDF, visit the AJCC website at www.ajcconline.org.
About the American Journal of Critical Care: The American Journal of Critical Care (AJCC), a bimonthly scientific journal published by the American Association of Critical-Care Nurses, provides leading-edge clinical research that focuses on evidence-based-practice applications. Established in 1992, the award-winning journal includes clinical and research studies, case reports, editorials and commentaries. AJCC enjoys a circulation of more than 130,000 acute and critical care nurses and can be accessed at www.ajcconline.org.
About the American Association of Critical-Care Nurses: For more than 50 years, the American Association of Critical-Care Nurses (AACN) has been dedicated to acute and critical care nursing excellence. The organization’s vision is to create a healthcare system driven by the needs of patients and their families in which acute and critical care nurses make their optimal contribution. AACN is the world’s largest specialty nursing organization, with more than 130,000 members and over 200 chapters in the United States.
American Association of Critical-Care Nurses, 27071 Aliso Creek Road, Aliso Viejo, CA 92656; 949-362-2000; www.aacn.org; facebook.com/aacnface; twitter.com/aacnme
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