Department of Intensive Care Medicine, School of Medicine, Sapporo Medical University, Sapporo 060-8556, Japan.
Medicina (Kaunas). 2022 Oct 27;58(11):1532. doi: 10.3390/medicina58111532.
Background and Objectives: The main objective of a transitional care program (TCP) is to detect patients with early deterioration following intensive care unit (ICU) discharge in order to reduce unplanned ICU readmissions. Consensus on the effectiveness of TCPs in preventing unscheduled ICU readmissions remains lacking. In this case study assessing the effectiveness of TCP, we focused on the association of unplanned ICU readmission with high nursing activities scores (NASs), which are considered a risk factor for ICU readmission. Materials and Methods: This retrospective observational study analyzed the data of patients admitted to a single-center ICU between January 2016 and December 2019, with an NAS of >53 points at ICU discharge. The following data were extracted: patient characteristics, ICU treatment, acute physiology and chronic health evaluation II (APACHE II) score at ICU admission, Charlson comorbidity index (CCI), 28-day mortality rate, and ICU readmission rate. The primary outcome was the association between unplanned ICU readmissions and the use of a TCP. The propensity score (PS) was calculated using the following variables: age, sex, APACHE II score, and CCI. Subsequently, logistic regression analysis was performed using the PS to evaluate the outcomes. Results: A total of 143 patients were included in this study, of which 87 (60.8%) participated in a TCP. Respiratory failure was the most common cause of unplanned ICU readmission. The unplanned ICU readmission rate was significantly lower in the TCP group. In the logistic regression model, TCP (odds ratio, 5.15; 95% confidence interval, 1.46−18.2; p = 0.01) was independently associated with unplanned ICU readmission. Conclusions: TCP intervention with a focus on patients with a high NAS (>53 points) may prevent unplanned ICU readmission.
过渡护理计划（TCP）的主要目标是检测 ICU 出院后早期恶化的患者，以减少非计划性 ICU 再入院。但 TCP 预防非计划性 ICU 再入院的有效性仍存在争议。在本案例研究中，我们评估了 TCP 的有效性，重点关注与非计划性 ICU 再入院相关的高护理活动评分（NAS），NAS 被认为是 ICU 再入院的一个风险因素。
这是一项回顾性观察性研究，分析了 2016 年 1 月至 2019 年 12 月期间入住单中心 ICU 的患者数据，这些患者在 ICU 出院时的 NAS ＞53 分。提取的数据包括患者特征、ICU 治疗、入 ICU 时急性生理学和慢性健康评估 II（APACHE II）评分、Charlson 合并症指数（CCI）、28 天死亡率和 ICU 再入院率。主要结局是非计划性 ICU 再入院与 TCP 使用之间的关系。采用年龄、性别、APACHE II 评分和 CCI 等变量计算倾向评分（PS）。随后，使用 PS 进行 logistic 回归分析评估结局。
本研究共纳入 143 例患者，其中 87 例（60.8%）参加了 TCP。呼吸衰竭是非计划性 ICU 再入院的最常见原因。TCP 组的非计划性 ICU 再入院率显著降低。在 logistic 回归模型中，TCP（比值比，5.15；95%置信区间，1.46−18.2；p = 0.01）与非计划性 ICU 再入院独立相关。
以高 NAS（＞53 分）患者为重点的 TCP 干预措施可能预防非计划性 ICU 再入院。
