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The Impact of Step-Down Unit Care on Patient Outcomes After ICU Discharge
| Content Provider | Scilit |
|---|---|
| Author | Lekwijit, Suparerk Chan, Carri W. Green, Linda V. Liu, Vincent X. Escobar, Gabriel J. |
| Copyright Year | 2020 |
| Description | Journal: Critical Care Explorations 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. |
| Related Links | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7259559/pdf |
| ISSN | 26398028 |
| e-ISSN | 26398028 |
| DOI | 10.1097/cce.0000000000000114 |
| Journal | Critical Care Explorations |
| Issue Number | 5 |
| Volume Number | 2 |
| Language | English |
| Publisher | Ovid Technologies (Wolters Kluwer Health) |
| Publisher Date | 2020-01-01 |
| Access Restriction | Open |
| Subject Keyword | Journal: Critical Care Explorations Critical Care Medicine Admission Decision, Hospital Bed Capacity, Hospital Length of Stay, Patient Readmission, Quality of Healthcare, Step-down Unit, Transitional Care |
| Content Type | Text |
| Resource Type | Article |
| Subject | Critical Care and Intensive Care Medicine |
