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Out-of-hours discharge from intensive care is strongly associated with both in-hospital death and ICU readmission.

Intensive care Chaikom/Shutterstock

Our Critical Care Research Group has published the first paper feeding into its REFLECT research programme. The work was funded by the NIHR Oxford Biomedical Research Centre.

Background

Most patients discharged from an intensive care unit (ICU) are expected to go home. However, about 1 in 12 die unexpectedly on general wards before leaving hospital.

The high death rate occurs despite hospitals using ‘early warning’ scoring systems and visits from ICU teams. We urgently need a plan which reduces this death rate - and that's where this research programme comes in.

Research findings

Transferring patients from intensive care to hospital wards sometimes happens overnight when there are fewer staff on the wards.

The analysis of data from 18 studies across the world shows a strong link between being discharged at night and death or readmission to intensive care.

These effects remained across all definitions of out-of-hours and across healthcare systems in different geographical locations. Whether these increases in mortality and readmission result from patient differences, differences in care, or a combination remains unclear.

implications

This study adds to ongoing research investigating what happens to patients once they leave intensive care.The REFLECT research programme will provide an in-depth picture of post-ICU ward management in three NHS trusts.

The findings from the project will help researchers and practitioners work together to improve post-ICU patient outcome. This could include reducing out-of-hours discharge, or at least acknowledging it as suboptimal, and putting in place measures that would support patients on the ward.

Read the full paper online