The Impact of Step-Down Unit Care on Patient Outcomes After ICU Discharge.

Critical Care Explorations
Suparerk LekwijitGabriel J Escobar

Abstract

To examine whether and how step-down unit admission after ICU discharge affects patient outcomes. Retrospective study using an instrumental variable approach to remove potential biases from unobserved differences in illness severity for patients admitted to the step-down unit after ICU discharge. Ten hospitals in an integrated healthcare delivery system in Northern California. Eleven-thousand fifty-eight episodes involving patients who were admitted via emergency departments to a medical service from July 2010 to June 2011, were admitted to the ICU at least once during their hospitalization, and were discharged from the ICU to the step-down unit or the ward. None. Using congestion in the step-down unit as an instrumental variable, we quantified the impact of step-down unit care in terms of clinical and operational outcomes. On average, for ICU patients with lower illness severity, we found that availability of step-down unit care was associated with an absolute decrease in the likelihood of hospital readmission within 30 days of 3.9% (95% CI, 3.6-4.1%). We did not find statistically significant effects on other outcomes. For ICU patients with higher illness severity, we found that availability of step-down unit care was associa...Continue Reading

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Citations

Jun 24, 2021·American Journal of Critical Care : an Official Publication, American Association of Critical-Care Nurses·Eileen KimLiron Sinvani

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