A 24-Hour Postintensive Care Unit Transition-of-Care Model Shortens Hospital Stay

Fayez Kheir; Khaled Shawwa; Du Nguyen; Abdul Hamid Alraiyes; Francesco Simeone; Nathan D Nielsen

doi:10.1177/0885066615569701

A 24-Hour Postintensive Care Unit Transition-of-Care Model Shortens Hospital Stay

J Intensive Care Med. 2016 Oct;31(9):597-602. doi: 10.1177/0885066615569701. Epub 2015 Jan 30.

Authors

Fayez Kheir¹, Khaled Shawwa², Du Nguyen³, Abdul Hamid Alraiyes⁴, Francesco Simeone⁵, Nathan D Nielsen⁶

Affiliations

¹ Tulane University Health Sciences Center, Section of Pulmonary Diseases, Critical Care and Environmental Medicine, New Orleans, LA, USA fkheir@tulane.edu.
² Department of Internal Medicine, Good Samaritan Hospital, Cincinnati, OH, USA Scholars in Health Research Program, American University of Beirut, Beirut, Lebanon.
³ Department of General Surgery, Bassett Medical Center, Cooperstown, NY, USA.
⁴ Department of Medicine, Roswell Park Cancer Institute, Interventional Pulmonology, Buffalo, NY, USA.
⁵ Tulane University Health Sciences Center, Section of Pulmonary Diseases, Critical Care and Environmental Medicine, New Orleans, LA, USA.
⁶ Departments of Medicine and Pathology, University of Maryland School of Medicine, Baltimore, MD, USA.

PMID: 25636643
DOI: 10.1177/0885066615569701

Abstract

Background: Patients discharged early from the medical intensive care unit (MICU) are at risk of deterioration, MICU readmission, and increased mortality. An earlier discharge to a medical ward is desirable to reduce costs but it may adversely affect outcomes. To address this problem, a new model for the MICU transition of care was implemented at our academic center: The MICU team continued to manage all patients transferred from the MICU to the medical ward for at least 24 hours.

Methods: Data were collected for all MICU patients admitted 1 year before and 1 year after the intervention. Hospital length of stay (LOS) after transfer from the MICU, readmission rate, and mortality rate were compared before and after the intervention. A nonparsimonious propensity model based on 30 factors was used to identify matched preintervention and postintervention cohorts.

Results: A total of 618 of the 848 patients admitted to the MICU were transferred to medical ward during the year prior to the implementation of the new model, and 600 of the 883 patients were transferred during the following year. Pre- and postintervention cohorts were well matched (n = 483 patients in each group). Poisson regression analysis showed a decrease in the hospital LOS after MICU transfer by 1.17 days (P < .001) without a significant change in adjusted mortality (lower by 1.9%, P = .181) and MICU readmission rates (lower by 2%, P = .264).

Conclusion: A new model for the post-MICU transition of care, with the MICU team continuing to manage all patients transferred to the medical ward for at least 24 hours, significantly decreased duration of hospital stay after MICU transfer without affecting MICU readmission and mortality rate. The implementation of this model may lower medical costs and make transition of care safer without adverse outcomes.

Keywords: hospital stay; medical intensive care unit stay; mortality; posttransition of care; readmission.

MeSH terms

Critical Illness / rehabilitation
Critical Illness / therapy*
Female
Humans
Intensive Care Units / organization & administration*
Length of Stay / statistics & numerical data*
Male
Middle Aged
Patient Discharge
Patient Transfer
Retrospective Studies
Transitional Care* / organization & administration