Predictors of Adverse Events in Patients After Discharge From the Intensive Care Unit

Abstract

Background Patients discharged from the intensive care unit may be at risk of adverse events because of complex care needs. Objective To identify the types, frequency, and predictors of adverse events that occur in the 72 hours after discharge from an intensive care unit when no evidence of adverse events was apparent before discharge. Methods A predictive cohort study of 300 patients from an adult intensive care unit was undertaken. An internationally accepted protocol for chart audit was used. Frequency of adverse events was calculated, and logistic regression was used to determine independent predictors of adverse events. Results A total of 147 adverse events, 17 (11.6%) of which were defined as major, were incurred by 92 patients (30.7%). The 3 most common adverse events, hospital-incurred infection or sepsis (n = 32, 21.8%), hospital-incurred accident or injury (n = 17, 11.6%), and other complication such as deep vein thrombosis, pulmonary edema, or myocardial infarction (n = 17, 11.6%) accounted for 44.9% (n = 66) of all adverse events. Two predictors, respiratory rate less than 10/min or greater than or equal to 25/min and pulse rate exceeding 110/min, were significant independent predictors; requiring a high level of nursing care at the time of discharge was a significant predictor in univariate analysis but not in multivariate analysis. Conclusion Taking, recording, and reporting vital signs are important. Nursing care requirements of patients at discharge from the intensive care unit may be worthy of further investigation in studies of patients after discharge.

Factors associated with post‐intensive care unit adverse events: a clinical validation study

“…Two recent Australian studies examined post-ICU adverse events primarily using chart review (McLaughlin et al, 2007;Chaboyer et al, 2008). In one of these, patients who experienced an adverse event were more frequently discharged in the evening or night (McLaughlin et al, 2007).…”

Nurses’ experience of the transfer of ICU patients to general wards: A great responsibility and a huge challenge

“…number of intensive care beds and fewer financial resources can mean that patients move through the system as quickly as possible (Wu & Coyer, 2007) and can also increase night discharges (Goldfrad & Rowan, 2000). Buchner et al (2015) described how premature patient transfer increases the risk of medical error and adverse events, morbidity and mortality (Chaboyer, Thalib, Foster, Ball, & Richards, 2008). It can also lead to ICU readmission and rehospitalisation (Wu & Coyer, 2007).…”

Examining adverse events after intensive care unit discharge: Outcomes from a pilot questionnaire

“…10 This places vulnerable post-ICU patients at high risk for an adverse event as they might not continue to receive the care required. Research 11 has therefore found that up to a third of patients will experience an adverse event soon after ICU discharge. Consistent with adverse events in other patient populations, half or more of adverse events occurring after ICU discharge could be preventable with better standards of care.…”

“…Two recent Australian studies 11,12 identified factors contributing to adverse events in the post-ICU population. Patients who experienced an adverse event were older and required a high level of nursing care at the time of ICU discharge.…”

“…Patients who experienced an adverse event were older and required a high level of nursing care at the time of ICU discharge. 11 Delays in taking action for abnormal physiological signs and infrequent charting were evident 12 in post-ICU patients. Data collection in these studies occurred via medical chart review which, although a common method, has limitations.…”