Neto Raul, Carvalho Margarida, Paixão Ana Isabel, Fernandes Paula, Castelões Paula
Intensive Care, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, PRT.
Cureus. 2022 Jan 17;14(1):e21313. doi: 10.7759/cureus.21313. eCollection 2022 Jan.
Evaluate the impact of a post-discharge critical care transition program (CTP) on intensive care unit (ICU) readmission, in-hospital mortality, and six-month survival.
This was a prospective observational, single-center study, with a before-after design, in a critical care department in a tertiary hospital in Northern Portugal. Critically ill patients with ICU stay > 48 h or intermediate care stay >72 h or tracheostomized patients were included in the program. Historic controls included critically ill patients admitted in the six months prior to program implementation. The follow-up visit included a medical evaluation by an intensivist and a meeting with the attending physician. The primary outcome was critical care department readmission. Secondary outcomes were mortality at hospital discharge, 28-day, and six-month mortality. The readmission rate was compared between groups. Multivariate analysis and Kaplan-Meyer survival analysis were used to evaluate survival benefits.
Between September 2020 and March 2021, 132 patients were included in the CTP. The Control group included 196 patients. The intensivist's assessment led to management change in 15.1% of patients. The CTP group had a non-significant lower readmission rate (0.8% vs. 4.1%; p=0.09). Multivariate analysis showed a benefit for the CTP regarding in-hospital, 28-day, and six-month mortality. Kaplan-Meyer survival analysis showed improved survival in the CTP group.
The CTP reduced, non-significantly, the readmission rate, and significantly improved in-hospital and six-month mortality. Further analyses are needed to improve inclusion criteria and better allocate human resources.
评估出院后重症监护过渡计划（CTP）对重症监护病房（ICU）再入院率、院内死亡率和六个月生存率的影响。
这是一项前瞻性观察性单中心研究，采用前后设计，在葡萄牙北部一家三级医院的重症监护科进行。入住ICU超过48小时或接受中级护理超过72小时的重症患者或气管切开患者被纳入该计划。历史对照组包括在该计划实施前六个月入院的重症患者。随访包括由重症医学专家进行的医学评估以及与主治医生的会面。主要结局是重症监护科再入院。次要结局是出院时死亡率、28天死亡率和六个月死亡率。比较两组之间的再入院率。采用多变量分析和Kaplan-Meier生存分析来评估生存获益。
2020年9月至2021年3月期间，132例患者被纳入CTP。对照组包括196例患者。重症医学专家的评估导致15.1%的患者治疗方案改变。CTP组的再入院率略低（0.8%对4.1%；p=0.09），差异无统计学意义。多变量分析显示CTP在院内、28天和六个月死亡率方面有获益。Kaplan-Meier生存分析显示CTP组生存率有所提高。
CTP非显著降低了再入院率，并显著改善了院内和六个月死亡率。需要进一步分析以改进纳入标准并更好地分配人力资源。
