Critical care transition programs and the risk of readmission or death after discharge from an ICU: a systematic review and meta-analysis.

Abstract

To determine whether critical care transition programs reduce the risk of ICU readmission or death, when compared with standard care among adults who survived their incident ICU admission. MEDLINE, EMBASE, CENTRAL, CINAHL, and two clinical trial registries were searched from inception to October 2012. Studies that examined the effects of critical care transition programs on the risk of ICU readmission or death among patients discharged from ICU were selected for review. A critical care transition program included any rapid response team, medical emergency team, critical care outreach team, or ICU nurse liaison program that provided follow-up for patients discharged from ICU. Two reviewers independently extracted data on study characteristics, transition program characteristics, and outcomes (number of ICU readmissions and in-hospital deaths following discharge from ICU). From 3,120 citations, nine before-and-after studies were included. The studies examined medical-surgical populations and described transition programs that were a component of a hospital's outreach team (n = 6) or nurse liaison program (n = 3). Meta-analysis using a fixed-effect model demonstrated a reduced risk of ICU readmission (risk ratio, 0.87 [95% CI, 0.76-0.99]; p = 0.03; I2 = 0%) but no significant reduction in hospital mortality (risk ratio, 0.84 [95% CI, 0.66-1.05]; p = 0.1; I2 = 16%) associated with a critical care transition program. The risk of ICU readmission was similar whether the transition program was included within an outreach team or a nurse liaison program and did not depend on the presence of an intensivist. Critical care transition programs appear to reduce the risk of ICU readmission in patients discharged from ICU to a general hospital ward. Given methodological limitations of the included before-and-after studies, additional research should confirm these observations and explore the ideal model for these programs before recommending implementation.