Browsing by Author "Hosein, F Shaun"

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    An analysis of the risk of readmission or death following patient discharge from the intensive care unit
    (2013-09-04) Hosein, F Shaun; Stelfox, H. Tomas
    Introduction: The discharge of patients from the intensive care unit (ICU) to a hospital ward is a common transition of care that is associated with error and adverse events. Further identification of risk stratification tools, risk factors and overall adverse event rates may help identify high-risk patients and improve the ICU discharge process. Methods: Ovid EMBASE, Ovid MEDLINE, CINAHL, PUBMED and Cochrane Central Register of Controlled Trials were searched from the earliest available date through March 2013, plus reference lists and citations of all studies included in the systematic review. Data were extracted on the study design, setting, population, sample size, tool and outcomes. Results: The literature search identified 9,926 citations, of which 58 studies identifying eight tools and 41 risk factors met the inclusion criteria. Reported outcomes included ICU readmission and post-ICU mortality .We were able to determine a pooled ICU readmission rate of 6.3%(95% CI 5.5-7.2%). and post-ICU mortality rate of 7.4% (95% CI 6.6-8.2%). Pooling of identified risk factors facilitated the development of two ICU discharge meta-prediction models, which were tested in a local database yielding areas under receiver operator curves ranging from 0.72 to 0.97. Conclusions: Eight risk stratification tools and 41 risk factors were identified from systematic review. Two meta-prediction models were developed and tested; yielding promising results, but further optimization is warranted. Although risk stratification tools may help clinician decision-making, further evaluation of the existing tools’ effects on care is required prior to clinical implementation. The identification of pooled adverse event rates from systematic review is proposed to serve as ICU benchmarks, contributing to improvement of ICU quality of patient care.