Page 207 - Hospital Authority Convention 2018

Service Enhancement Presentations

F5.7 Healthcare Advances, Research and Innovations 09:00 Room 421

Effective Strategy to Reduce Readmission to Intensive Care Unit: An Experimental Study with Historical Control
Group
1
2
1
So HM , Yan WW , Chair SY , Intensive Care Unit Outreach Team1
1 Department of Intensive Care, Pamela Youde Nethersole Eastern Hospital, The Nethersole School of Nursing, The Chinese HOSPITAL AUTHORITY CONVENTION 2018
2
University of Hong Kong, Hong Kong
Introduction
Intensive care unit (ICU) readmissions have been associated with increased length of stay, mortality rate and healthcare
spending. Though various critical care outreach programmes have been developed and evaluated worldwide, heterogeneity
in methodology and target population posed difficulty in identifying optimal model of care, especially when none have been
done in a highly government subsidised healthcare system like Hong Kong.

Objectives
To evaluate the effectiveness of a nurse-led critical care follow-up programme on ICU readmissions and hospital mortality in
ICU discharged patients with respiratory problem.

Methodology
An experimental study design with a historical control group was employed. The ICU follow-up programme incorporated
structured follow-up visits at general wards, standardised vital signs monitoring, track and trigger system, bedside coaching
of general ward nurses, and consultation. Follow-up visits started within 24 hours after a patient’s ICU discharge to 72 hours
post-discharge. The outreach team was led by a nurse consultant with involvement of an advanced practice nurse and senior
ICU doctors. Patients with respiratory problem meeting the inclusion criteria were recruited. Both the intervention and control
periods lasted for 13 months. The primary outcome was ICU readmission within 72 hours, and the secondary outcomes
included all ICU readmission rate, hospital mortality, and 90-day mortality rate. Pearson Chi-square tests or Fisher’s exact
test was used to analyse outcome variables between two groups. Logistic regression analysis was used to determine the
predictors for ICU readmission within 72 hours.

Results
A total of 369 participants (185 in the intervention group, 184 in control group) were recruited. A significant reduction in ICU
readmission within 72 hours was observed in the intervention group compared to control group (9.2% to 1.6%. p<0.001), with
an 84.2% reduction in risk of early ICU readmission (OR: 0.158, 95% CI: 0.041, 0.602, p=0.007). Significant reduction in all
ICU readmission (9.7% vs. 23.9%, p < 0.001) and hospital mortality (17.8% vs. 26.6%, p=0.042), but not 90-day mortality rate
(15.7% vs. 22.8%, p = 0.081) was also noted in the intervention group. This nurse-led ICU follow-up programme was shown
to be cost-effective, saving an estimated HK$ 1,135,792 in a period of 13 months. The results of the study contributed to the
database of an innovative follow-up programme to share the practice locally and worldwide. Tuesday, 8 May 2018

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