Intensive Care National Audit & Research Centre, Tavistock House, Tavistock Square, London WC1H 9HR, UK.
J Crit Care. 2010 Jun;25(2):196-204. doi: 10.1016/j.jcrc.2009.12.015.
The purpose of the study was to evaluate the effect of visits from critical care outreach services (CCOS) before admission to and following discharge from critical care.
A cohort study was performed in 52 acute hospitals in England. A total of 23 234 patients received CCOS visits; 10 404 (45%) were admitted to a critical care unit, and 7078 (68%) were included in the analysis. Patients receiving CCOS visits before (n = 2203) and after (n = 5924) critical care were matched 1:1 to 3 control pools: historical admissions to the same unit before introduction of CCOS, admissions to a unit in a hospital with no CCOS, and contemporary admissions to the same unit not receiving CCOS visits. Matching was based on individual factors and on propensity.
The CCOS visits preadmission were not associated with differences in severity of illness, but were associated with lower rates of cardiopulmonary resuscitation, longer prior hospital stay, and longer unit stay. The CCOS visits postdischarge were associated with lower hospital mortality and shorter hospital stay in 2 matches, but not when compared with contemporary admissions to the same unit.
Our results suggest a benefit to scheduled follow-up visits of patients discharged from critical care. Results for CCOS before critical care are inconclusive.
本研究旨在评估在入住重症监护病房前后，重症监护病房外展服务（CCOS）的访视对患者的影响。
在英格兰的 52 家急性医院进行了一项队列研究。共有 23234 名患者接受了 CCOS 访视；其中 10404 名（45%）患者被收入重症监护病房，有 7078 名（68%）患者纳入分析。将接受 CCOS 访视的患者（n=2203）与重症监护前（n=5924）和重症监护后（n=5924）的患者进行 1:1 匹配至 3 个对照组：在引入 CCOS 前同一单位的同期住院患者、无 CCOS 的医院单位的住院患者和同一单位未接受 CCOS 访视的同期住院患者。匹配基于个体因素和倾向得分。
CCOS 预入院访视与疾病严重程度无差异相关，但与心肺复苏率较低、住院前住院时间较长和单位住院时间较长相关。CCOS 出院后访视与 2 个匹配组的住院死亡率降低和住院时间缩短相关，但与同一单位的同期住院患者相比则无差异。
我们的结果表明，对从重症监护病房出院的患者进行计划随访访视可能有益。在入住重症监护病房前进行 CCOS 的结果尚无定论。
