Association between resuscitation in the critical care resuscitation unit and in-hospital mortality

Miller, Taylor; Emamianb, Nikki; Glick, Zoe; Chen, Nelson; Cao, Tiffany; Buganu, Adelina; Cardona, Stephanie; Teeter, William; Haase, Daniel; Tran, Quincy

doi:10.1016/j.ajem.2022.07.042

Cited by 5 publications

(4 citation statements)

References 16 publications

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“…In today's saturated hospital systems, often operating near 100% capacity, there is an emphasis on ICU cost reduction and rapidity of hospital discharges, including from the ICU, when appropriate [ 11 ]. Findings from this study suggested that patients who were discharged directly from the CCRU were associated with improving physiological parameters, which was consistent with previous observations about the CCRU's effectiveness in lowering SOFA score and patients' improved outcome [ 12 ]. Thus, it is probably safe to discharge patients, even from a resuscitation unit, once the patients' symptoms or physiological parameters improved.…”

Section: Discussionsupporting

confidence: 91%

Direct Discharge from the Critical Care Resuscitation Unit: Results from a Longitudinal Assessment

Tran,

Widjaja,

Plotnikova

et al. 2023

Critical Care Research and Practice

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Background. The critical care resuscitation unit (CCRU) facilitates interhospital transfer (IHT) of critically ill patients for immediate interventions. Due to these patients’ acuity, it is uncommon for patients to be directly discharged home from this unit, but it does happen on occasion. Since there is no literature regarding outcomes of patients being discharged from a resuscitation unit, our study investigated these patients’ outcome at greater than 12 months after being discharged directly from the CCRU. Methods. We performed a retrospective cohort study of all adult patients directly discharged from the CCRU between January 01, 2017, and December 31, 2020. The primary outcome was number of ED visits or hospitalizations within 6 months. Secondary outcomes were number of ED visits or hospitalizations within 6, 12, and >12 months from CCRU discharge. Results. We analyzed 145 patients’ records. Mean age was 56 (standard deviation [SD] ± 19), with a majority being male (72%) and Caucasian (58%). The most common discharge destination was home (139 patients, 96% of total subjects) versus hospice (2%) or nursing facilities (2%). Most patients (55%) did not have any hospital revisits within the first 6 months of discharge, while 31% had 1-2 revisits, and 14% had ≥3 revisits. The most common discharge diagnoses were soft tissue infection (16.5%), aortic dissection (14%), and stroke (11%). Factors which were associated with a greater likelihood of any return hospital visit within 6 months receiving mechanical ventilation during CCRU stay (coefficient −2.23, 95% CI 0.01–0.87, P = 0.036 ), while high hemoglobin on CCRU discharge was associated with no ED revisit (coeff. 0.42, 95% CI 1.15–2.06, P = 0.004 ). Conclusions. Most patients who were discharged from the CCRU did not require any hospital revisits in the first 6 months. Requiring mechanical ventilation and having soft tissue infection were associated with high unplanned hospital revisits following discharge. Further research is needed to validate these findings.

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Section: Discussionsupporting

confidence: 91%

Direct Discharge from the Critical Care Resuscitation Unit: Results from a Longitudinal Assessment

Tran,

Widjaja,

Plotnikova

et al. 2023

Critical Care Research and Practice

Self Cite

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“…Although patients in this study were associated with improvement of their physiologic indices within 24 hours. Our analysis did not show an association whether this improvement was associated with outcomes although a previous study suggested that an improvement of SOFA score, even during a short period of time, would be associated with patient’s increased odds of hospital survival [ 19 ]. The discrepancies could be multifactorial.…”

Section: Discussioncontrasting

confidence: 64%

Clinical characteristics and outcomes of obstetric patients transferred directly to intensive care units

Pirzada,

Boswell,

Yang

et al. 2024

ACC

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Background: Medical complications in peripartum patients are uncommon; however, such events in patients already under biological stress can lead to poor outcomes. Often, these patients are transferred to tertiary care centers, but their conditions and outcomes are not well understood. Our study looked at peripartum patients transferred to an intensive care unit (ICU) at an academic quaternary center.Methods: We reviewed charts of adult, non-trauma, interhospital transfer (IHT) peripartum patients sent to an academic quaternary ICU between January 2017 and December 2021. We conducted a descriptive analysis and used multivariable ordinal regression to examine associations of demographic and clinical factors with ICU length of stay (ICU LOS) and hospital length of stay (HLOS).Results: Of 1,794 IHT peripartum patients, 60 (3.2%) were directly transferred to an ICU. The average age was 32 years, with a median Sequential Organ Failure Assessment (SOFA) score of 3 (1–4.25) and median Acute Physiology and Chronic Health Evaluation (APACHE) II score of 8 (7–12). Respiratory failure was most common (32%), followed by postpartum hemorrhage (15%) and sepsis (14%). Intubation was required for 24 (41%), and 4 (7%) needed extracorporeal membrane oxygenation. Only 1 (1.7%) died, while 45 (76.3%) were discharged. Median ICU LOS and HLOS were 5 days (2–12) and 8 days (5–17). High SOFA was linked to longer HLOS, as was APACHE II score.Conclusions: Transfers of critically ill peripartum patients between hospitals were rare but involved severe medical conditions. Despite this, their outcomes were generally positive. Larger studies are needed to confirm our findings.

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“…We have published several studies showing impact upon several patient-oriented and logistical outcomes. Since our opening in 2013, we have demonstrated a lower mortality and more rapid time to transfer (2) of critically ill patients, reduction in transfer time in ischemic stroke (3), improved time to neurosurgical intervention (4) and reduced blood pressure variability in the acute period following intracranial hemorrhage (5), decreased time to operative intervention (6), improved patient flow metrics for the medical center as a whole (7), and reduction in Sequential Organ Failure Assessment score of patients with shock during their short stay in the CCRU, which was associated with lower odds of hospital mortality (8).…”

Section: To the Editormentioning

confidence: 99%

Critical Care Resuscitation Unit Model Shows Benefit for Patients, Patient Flow Metrics, and the Medical System

Teeter

Tran

Haase

2022

Critical Care Medicine

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Association between resuscitation in the critical care resuscitation unit and in-hospital mortality

Cited by 5 publications

References 16 publications

Direct Discharge from the Critical Care Resuscitation Unit: Results from a Longitudinal Assessment

Direct Discharge from the Critical Care Resuscitation Unit: Results from a Longitudinal Assessment

Clinical characteristics and outcomes of obstetric patients transferred directly to intensive care units

Critical Care Resuscitation Unit Model Shows Benefit for Patients, Patient Flow Metrics, and the Medical System

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