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Critical Care Transition Programs and the Risk of Readmission or Death After Discharge From an ICU: A Systematic Review and Meta-Analysis*

Niven, Daniel J. MD, MSc, FRCPC1,2,3; Bastos, Jaime F. MD, PhD1,2,4; Stelfox, Henry T. MD, PhD, FRCPC1,2,3,5

doi: 10.1097/CCM.0b013e3182a272c0
Review Articles

Objective: To determine whether critical care transition programs reduce the risk of ICU readmission or death, when compared with standard care among adults who survived their incident ICU admission.

Data Sources: MEDLINE, EMBASE, CENTRAL, CINAHL, and two clinical trial registries were searched from inception to October 2012.

Study Selection: Studies that examined the effects of critical care transition programs on the risk of ICU readmission or death among patients discharged from ICU were selected for review. A critical care transition program included any rapid response team, medical emergency team, critical care outreach team, or ICU nurse liaison program that provided follow-up for patients discharged from ICU.

Data Extraction: Two reviewers independently extracted data on study characteristics, transition program characteristics, and outcomes (number of ICU readmissions and in-hospital deaths following discharge from ICU).

Data Synthesis: From 3,120 citations, nine before-and-after studies were included. The studies examined medical-surgical populations and described transition programs that were a component of a hospital’s outreach team (n = 6) or nurse liaison program (n = 3). Meta-analysis using a fixed-effect model demonstrated a reduced risk of ICU readmission (risk ratio, 0.87 [95% CI, 0.76–0.99]; p = 0.03; I2 = 0%) but no significant reduction in hospital mortality (risk ratio, 0.84 [95% CI, 0.66–1.05]; p = 0.1; I2 = 16%) associated with a critical care transition program. The risk of ICU readmission was similar whether the transition program was included within an outreach team or a nurse liaison program and did not depend on the presence of an intensivist.

Conclusions: Critical care transition programs appear to reduce the risk of ICU readmission in patients discharged from ICU to a general hospital ward. Given methodological limitations of the included before-and-after studies, additional research should confirm these observations and explore the ideal model for these programs before recommending implementation.

1Department of Critical Care Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada.

2Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.

3Institute for Public Health, University of Calgary, Calgary, AB, Canada.

4Department of Critical Care, Albert Einstein Hospital, Sao Paolo, Brazil.

5Department of Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada.

* See also p. 216.

This work was performed at the University of Calgary.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).

Dr. Niven is funded through a Clinician Fellowship Award from Alberta Innovates–Health Solutions and a Knowledge Translation Canada Student Fellowship and Training Program grant (government granting agencies salary awards with no influence on conduct/design of the study). Dr. Stelfox is supported by a New Investigator Award from the Canadian Institutes of Health Research and a Population Health Investigator Award from Alberta Innovates–Health Solutions. The funding agencies did not contribute to design or conduct of the study; collection, management, analysis, or interpretation of the data; or preparation, review, or approval of the final manuscript. Dr. Bastos has disclosed that he does not have any potential conflicts of interest.

For information regarding this article, E-mail: tstelfox@ucalgary.ca

© 2014 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins