The Impact of Step-Down Unit Care on Patient Outcomes After ICU Discharge.
The Impact of Step-Down Unit Care on Patient Outcomes After ICU Discharge.
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DOI：
10.1097/cce.0000000000000114
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发表时间：
2020-05-01
影响因子：
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通讯作者：
Escobar, Gabriel J
中科院分区：
文献类型：
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作者：
Lekwijit, Suparerk;Chan, Carri W;Escobar, Gabriel J
目的：研究ICU出院后逐步入院是否以及如何影响患者的预后。设计：使用工具变量方法进行回顾性研究，消除因ICU出院后患者病情严重程度差异而产生的潜在偏差。设置：在北加州的一个综合医疗服务系统中的10家医院。患者：11,058例涉及2010年7月至2011年6月通过急诊科入院的患者，在住院期间至少入院一次，干预：无。测量和主要结果：以降压病房的充血为工具变量，我们量化了降压病房护理对临床和手术结果的影响。平均而言，对于病情严重程度较低的ICU患者，我们发现分级病房护理的可用性与30天内再次住院的可能性绝对减少3.9%(95%可信区间，3.6-4.1%)相关。我们没有发现对其他结果有统计学意义的影响。对于病情严重程度较高的ICU患者，我们发现分级病房护理的可用性与住院死亡率绝对降低2.5%(95%CI，2.3-2.6%)、剩余住院时间减少1.1天(95%CI，1.0-1.2d)以及在5天内再次住院的可能性降低3.6%(95%CI，3.3%-3.8%)。结论：这项研究表明，有一部分出院的患者可能受益于相对于病房的降级病房的护理。我们发现，逐步减少单元护理与患者预后的统计上的显着改善有关，特别是对于高危患者。我们的结果表明，降压式病房可以为ICU患者提供有效的过渡护理。
OBJECTIVES: To examine whether and how step-down unit admission after ICU discharge affects patient outcomes.DESIGN: Retrospective study using an instrumental variable approach to remove potential biases from unobserved differences in illness severity for patients admitted to the step-down unit after ICU discharge.SETTING: Ten hospitals in an integrated healthcare delivery system in Northern California.PATIENTS: Eleven-thousand fifty-eight episodes involving patients who were admitted via emergency departments to a medical service from July 2010 to June 2011, were admitted to the ICU at least once during their hospitalization, and were discharged from the ICU to the step-down unit or the ward.INTERVENTIONS: None.MEASUREMENTS AND MAIN RESULTS: Using congestion in the step-down unit as an instrumental variable, we quantified the impact of step-down unit care in terms of clinical and operational outcomes. On average, for ICU patients with lower illness severity, we found that availability of step-down unit care was associated with an absolute decrease in the likelihood of hospital readmission within 30 days of 3.9% (95% CI, 3.6-4.1%). We did not find statistically significant effects on other outcomes. For ICU patients with higher illness severity, we found that availability of step-down unit care was associated with an absolute decrease in in-hospital mortality of 2.5% (95% CI, 2.3-2.6%), a decrease in remaining hospital length-of-stay of 1.1 days (95% CI, 1.0-1.2 d), and a decrease in the likelihood of ICU readmission within 5 days of 3.6% (95% CI, 3.3-3.8%).CONCLUSIONS: This study shows that there exists a subset of patients discharged from the ICU who may benefit from care in an step-down unit relative to that in the ward. We found that step-down unit care was associated with statistically significant improvements in patient outcomes especially for high-risk patients. Our results suggest that step-down units can provide effective transitional care for ICU patients.