BMJ 2001;322:1274 ( 26 May )

Papers

Reduction in mortality after inappropriate early discharge from intensive care unit: logistic regression triage model

Kathleen Daly, research nurse, ^a R Beale, consultant intensive care physician, ^a R W S Chang, consultant transplant surgeon. ^b

^a St Thomas's Hospital, London SE1 7EH, ^b St George's Hospital, London SW17 0QT

Correspondence to: R W S Chang renechang{at}compuserve.com

Objective: To develop a predictive model to triage patients for discharge from intensive care units to reduce mortality after discharge.
Design: Logistic regression analyses and modelling of data from patients who were discharged from intensive care units.
Setting: Guy's hospital intensive care unit and 19 other UK intensive care units from 1989 to 1998.
Participants: 5475 patients for the development of the model and 8449 for validation.
Main outcome measures: Mortality after discharge and power of triage model.
Results: Mortality after discharge from intensive care was up to 12.4%. The triage model identified patients at risk from death on the ward with a sensitivity of 65.5% and specificity of 87.6%, and an area under the receiver operating curve of 0.86. Variables in the model were age, end stage disease, length of stay in unit, cardiothoracic surgery, and physiology. In the validation dataset the 34% of the patients identified as at risk had a discharge mortality of 25% compared with a 4% mortality among those not at risk.
Conclusions: The discharge mortality of at risk patients may be reduced by 39% if they remain in intensive care units for another 48 hours. The discharge triage model to identify patients at risk from too early and inappropriate discharge from intensive care may help doctors to make the difficult clinical decision of whom to discharge to make room for a patient requiring urgent admission to the unit. If confirmed, this study has implications on the provision of resources.

What is already known on this topic In the United Kingdom, the mortality of patients who die on the ward after discharge from intensive care is unacceptably high (9% to 27%) Indirect evidence has shown that this is due to too early and inappropriate discharge from intensive care that has increased over the past 10 years What this study adds A triage model identifies patients at risk from inappropriate discharge from intensive care Mortality after discharge from intensive care may be reduced by 39% if these patients were to stay in intensive care for another 48 hours An estimated 16% more beds are required if mortality after discharge from intensive care is to be reduced

---

© BMJ 2001
CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

Relevant Articles

Mortality after discharge from intensive care

Andrew Inglis, Richard Price, Julian Bion, Michael J O'Leary, and David J Bihari
BMJ 2001 323: 629. [Extract] [Full Text]

Delaying discharge from intensive care saves lives
BMJ 2001 322: 0. [Full Text]

Safer discharge from intensive care to hospital wards

Klim McPherson
BMJ 2001 322: 1261-1262. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

• Campbell, A. J., Cook, J. A., Adey, G., Cuthbertson, B. H. (2008). Predicting death and readmission after intensive care discharge. Br J Anaesth 100: 656-662 [Abstract] [Full text]  
• Peberdy, M. A., Cretikos, M., Abella, B. S., DeVita, M., Goldhill, D., Kloeck, W., Kronick, S. L., Morrison, L. J., Nadkarni, V. M., Nichol, G., Nolan, J. P., Parr, M., Tibballs, J., van der Jagt, E. W., Young, L. (2007). Recommended Guidelines for Monitoring, Reporting, and Conducting Research on Medical Emergency Team, Outreach, and Rapid Response Systems: An Utstein-Style Scientific Statement: A Scientific Statement From the International Liaison Committee on Resuscitation (American Heart Association, Australian Resuscitation Council, European Resuscitation Council, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Southern Africa, and the New Zealand Resuscitation Council); the American Heart Association Emergency Cardiovascular Care Committee; the Council on Cardiopulmonary, Perioperative, and Critical Care; and the Interdisciplinary Working Group on Quality of Care and Outcomes Research. Circulation 116: 2481-2500 [Full text]  
• Dawwas, M F, Gimson, A E, Lewsey, J D, Copley, L P, van der Meulen, J H P, on behalf of the UK and Ireland Liver Transplant A, (2007). Survival after liver transplantation in the United Kingdom and Ireland compared with the United States. Gut 56: 1606-1613 [Abstract] [Full text]  
• Reilly, B. M., Evans, A. T. (2006). Translating Clinical Research into Clinical Practice: Impact of Using Prediction Rules To Make Decisions. ANN INTERN MED 144: 201-209 [Abstract] [Full text]  
• Goldhill, D. R. (2005). Preventing surgical deaths: critical care and intensive care outreach services in the postoperative period. Br J Anaesth 95: 88-94 [Full text]  
• Garland, A. (2005). Improving the ICU: Part 1. Chest 127: 2151-2164 [Abstract] [Full text]  
• Ball, C., Kirkby, M., Williams, S. (2003). Effect of the critical care outreach team on patient survival to discharge from hospital and readmission to critical care: non-randomised population based study. BMJ 327: 1014- [Abstract] [Full text]  
• Kogan, A., Cohen, J., Raanani, E., Sahar, G., Orlov, B., Singer, P., Vidne, B. A. (2003). Readmission to the intensive care unit after "fast-track" cardiac surgery: risk factors and outcomes. Ann. Thorac. Surg. 76: 503-507 [Abstract] [Full text]  
• (2003). OTHER ARTICLES NOTED (Nov 01 to 18 Oct 02). Evid. Based Nurs. 6: e1-1 [Full text]  
• Inglis, A., Price, R., Bion, J., O'Leary, M. J, Bihari, D. J (2001). Mortality after discharge from intensive care. BMJ 323: 629-629 [Full text]  
• McPherson, K. (2001). Safer discharge from intensive care to hospital wards. BMJ 322: 1261-1262 [Full text]  

Rapid Responses:

Read all Rapid Responses

HDUs, not more ICU beds

Stephen Stott
bmj.com, 25 May 2001 [Full text]

ICU Follow up team is the next logical extension

Milind P Sovani
bmj.com, 27 May 2001 [Full text]

Re; Mortality after discharge from intensive care

Andrew Inglis, et al.
bmj.com, 11 Jun 2001 [Full text]

Reduction in mortality after discharge from ICU

William Konarzewski
bmj.com, 14 Jun 2001 [Full text]

Hospital mortality prediction at ICU discharge

Nicolás Serrano, et al.
bmj.com, 15 Jun 2001 [Full text]

The role of high dependency unit care

D L Crosby
bmj.com, 6 Jul 2001 [Full text]

Online poll

Find out more >>