After-Hours/Nighttime Transfers Out of the Intensive Care Unit and Patient Outcomes: A Systematic Review and Meta-Analysis

Moshynskyy, Anton; Mailman, Jonathan F; Sy, Eric

doi:10.1177/0885066620984410

Cited by 6 publications

(5 citation statements)

References 51 publications

(143 reference statements)

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“…A review article supports this finding, noting an increased risk for readmissions to ICUs related to transfers during evening and nighttime (Elliott et al, 2014 ). Another review and meta‐analysis showed that after‐hours transfers were associated with increased in‐hospital mortality, ICU readmission and length of hospital stay (Moshynskyy et al, 2022 ). Consequently, international recommendations state that patient transfer should preferably happen during the daytime (National Institute for Health and Care Excellence, 2020 ).…”

Section: Discussionmentioning

confidence: 99%

Patient transfer from intensive care units to general wards: An exploratory qualitative study of ward nurses' experiences of patient safety

Nikolaisen,

Fridh,

Olsen

2023

Nursing Open

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AimPatient transfer from intensive care units (ICUs) to general wards is a routine part of hospital care. However, if the transfer is not optimal, it can result in increased readmissions to the ICU, increased stress and discomfort for the patient and, thus, a threat to patient safety. The aim of this study was to explore how general ward nurses experience patient safety during patient transfers from ICUs to general wards.DesignA qualitative design based on a phenomenological approach was used.MethodsTwo focus group interviews were conducted with a total of eight nurses from a medical ward and a surgical ward at one hospital in Norway. The data were analysed using systematic text condensation.ResultsThe nurses' experiences of patient safety during patient transfer had four themes: (1) the importance of preparedness; (2) the importance of the handover of information; (3) stress and a lack of resources and (4) a feeling of two different worlds.ConclusionIn order to promote patient safety, the informants highlighted the importance of being well prepared for transfer, and to have optimal handover of information. Stress, lack of resources and a feeling of two different worlds may pose threats to patient safety.Implications for the Profession and/or Patient CareWe suggest several intervention studies testing the effect of intervention improving patient safety during the transfer process are designed, and that increased knowledge in this area is used to develop local practice recommendations.Patient or Public ContributionThe participants of this study were nurses and this contribution has been explained in the Data collection section. There was no patient contribution in this study.

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Section: Discussionmentioning

confidence: 99%

Patient transfer from intensive care units to general wards: An exploratory qualitative study of ward nurses' experiences of patient safety

Nikolaisen,

Fridh,

Olsen

2023

Nursing Open

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“…Moshynskyy et al (28) and Yang et al (29) reported that nighttime transfers from the ICU were associated with higher hospital mortality. A systematic review and meta-analysis by Vollam et al (17) showed that out-of-hours discharge from ICU was significantly associated with hospital mortality.…”

Section: Discussionmentioning

confidence: 99%

“…In our study, it is likely that the improper ratio of nursing staff limited the attainment of high SSC 1-h bundle, thus increasing the death of patients with sepsis. Moshynskyy et al (28) and Yang et al (29) reported that nighttime transfers from the ICU were associated with higher hospital mortality. A systematic review and meta-analysis by Vollam et al (17) showed that out-ofhours discharge from ICU was significantly associated with hospital mortality.…”

Section: Discussionmentioning

confidence: 99%

Effect of Admission and Discharge Times on Hospital Mortality in Patients With Sepsis

Zhou

Weng

et al. 2022

Critical Care Medicine

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To assess whether the time of admission/discharge time from the ICU and weekend admission are independently associated with hospital mortality in critically ill patients with sepsis.DESIGN: Retrospective study. Each 24-hour period (08:00 to 07:59 hr) was split into three time periods, defined as "day" (08:00 to 16:59 hr), "evening" (17:00 to 23:59 hr), and "night" (00:00 to 07:59 hr). Weekends were defined as 17:00 hours on Friday to 07:59 hours on Monday. Multivariate logistic regression models were conducted to assess the association between the ICU admission/discharge time, weekend admission, and hospital mortality. SETTING:Single-center ICUs in China. PATIENTS:Characteristics and clinical outcomes of 1,341 consecutive septic patients admitted to the emergency ICU, general ICU, or cardiovascular ICU in a tertiary teaching hospital were collected. INTERVENTIONS: None.MEASUREMENTS AND MAIN RESULTS: ICU mortality rates were 5.8%, 11.9%, and 10.6%, and hospital mortality rates were 7.3%, 15.6%, and 17.1% during the day, evening, and night time, respectively. Hospital mortality was adjusted for patient to nurse (P/N) ratio, disease severity, Charlson index, age, gender, mechanical ventilation, and shock. Notably, ICU admission time and weekend admission were not predictors of mortality after adjustment. The P/N ratio at admission was significantly associated with mortality (p < 0.05). The P/N ratio and compliance with the Surviving Sepsis Campaign (SSC) were significantly correlated. After risk adjustment for illness severity at time of ICU discharge and Charlson index, the time of discharge was no longer a significant predictor of mortality.CONCLUSIONS: ICU admission/discharge time and weekend admission were not independent risk factors of hospital mortality in critically ill patients with sepsis. The P/N ratio at admission, which can affect the compliance rate with SSC, was a predictor of hospital survival. Unstable state on transfer from the ICU was the main risk factor for in-hospital death. These findings may have implications for the management of septic patients.

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“…NSM provides the guidance needed to prevent stress and the subsequent negative impact on the health of CMC. Frequent stressors for patients and CMC transferring from the ICU to the general acute care unit include inconsistent and inadequate handoff between nurses, incomplete medication reconciliation, rapid alterations in sedation, and timing of the patient transfer (Blazin et al, 2020; Duceppe et al, 2019; Herbst et al, 2018; Moshynskyy et al, 2022; Österlind et al, 2020).…”

Section: Nursing Implicationsmentioning

confidence: 99%

Improving Transitions in Care for the Child with Medical Complexity Using Betty Neuman’s Systems Model

Van Orne

2024

Nurs Sci Q

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Children with medical complexity are an increasing population with frequent use of intensive care services within hospitals. As children’s health improves, they are often transferred to a general unit before being discharged to home. This transition often leads to an acute decline in health, resulting in emergent interventions. Betty Neuman’s systems model provides the foundation to guide prevention interventions on stress mitigation to promote stability. An evidence-based transition bundle of care may be a valuable tool to prevent stress at the time of transfer from the intensive care unit and prevent deterioration.

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After-Hours/Nighttime Transfers Out of the Intensive Care Unit and Patient Outcomes: A Systematic Review and Meta-Analysis

Cited by 6 publications

References 51 publications

Patient transfer from intensive care units to general wards: An exploratory qualitative study of ward nurses' experiences of patient safety

Patient transfer from intensive care units to general wards: An exploratory qualitative study of ward nurses' experiences of patient safety

Effect of Admission and Discharge Times on Hospital Mortality in Patients With Sepsis

Improving Transitions in Care for the Child with Medical Complexity Using Betty Neuman’s Systems Model

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