The association between nighttime transfer from the intensive care unit and patient outcome*

Hanane, Tarik; Keegan, Mark T.; Seferian, Edward G.; Gajic, Ognjen; Afessa, Bekele

doi:10.1097/ccm.0b013e3181809ca9

Cited by 62 publications

(84 citation statements)

References 15 publications

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“…Previous studies have shown that bed availability can negatively affect transfers from ICU when patients are transferred before they otherwise would be (e.g., owing to an influx of more acute patients). 19,20 Conversely, participants in our study also cited long transfer processes as a barrier to high-quality transfers where patients ready for transfer waited days for a hospital ward bed to become available. They reported variable quality of care during this "waiting period" with confusion or a lack of accountability about who is most responsible for the patient.…”

Section: Resource Availabilitymentioning

confidence: 95%

Patient, family and provider experiences with transfers from intensive care unit to hospital ward: a multicentre qualitative study

Grood

Leigh

Bagshaw

et al. 2018

CMAJ

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BACKGROUND: Transfer of patient care from an intensive care unit (ICU) to a hospital ward is often challenging, high risk and inefficient. We assessed patient and provider perspectives on barriers and facilitators to high-quality transfers and recommendations to improve the transfer process. METHODS:We conducted semi structured interviews of participants from a multicentre prospective cohort study of ICU transfers conducted at 10 hospitals across Canada. We purposively sampled 1 patient, 1 family member of a patient, 1 ICU provider, and 1 ward provider at each of the 8 English-speaking sites. Qualitative content analysis was used to derive themes, subthemes and recommendations.RESULTS: The 35 participants described 3 interrelated, overarching themes perceived as barriers or facilitators to high-quality patient transfers: resource availability, communication and institutional culture. Common recommendations suggested to improve ICU transfers included implementing standardized communication tools that streamline provider-provider and providerpatient communication, using multimodal communication to facilitate timely, accurate, durable and mutually reinforcing information transfer; and developing procedures to manage delays in transfer to ensure continuity of care for patients in the ICU waiting for a hospital ward bed. HEALTH SERVICES

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Section: Resource Availabilitymentioning

confidence: 95%

Patient, family and provider experiences with transfers from intensive care unit to hospital ward: a multicentre qualitative study

Grood

Leigh

Bagshaw

et al. 2018

CMAJ

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“…[27][28][29][30] Any factor that weakens communication between an ICU nurse and the oncall physician during this period can adversely affect patients' safety and outcome.…”

Section: Discussionmentioning

confidence: 99%

“…[27][28][29][30] Any factor that weakens communication between an ICU nurse and the oncall physician during this period can adversely affect patients' safety and outcome. 1,4,7 Our study, the first evaluation of the perceptions and practices of ICU nurses and physicians about the communication they have with each other at night, in the context of pain, agitation, and delirium, raises a number of concerns.…”

Section: Discussionmentioning

confidence: 99%

Perceptions of Nurses and Physicians of Their Communication at Night About Intensive Care Patients' Pain, Agitation, and Delirium

Al-Qadheeb¹,

Hoffmeister²,

Roberts³

et al. 2013

American Journal of Critical Care

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Background Ineffective daytime nurse-physician communication in intensive care adversely affects patients' outcomes. Nurses' and physicians' communications and perceptions of this communication at night are unknown. Objectives To determine perceptions of nurses and physicians of their communication with each other at night in the intensive care unit about patients' pain, agitation, and delirium and to develop a qualitative survey instrument to investigate this topic. Methods A validated survey was distributed to nighttime nurses and physicians in 2 medical intensive care units. Results Most nurses (30/45; 67%) and physicians (56/75; 75%) responded. Nurses (35%) and physicians (31%) thought that a similar proportion of communications was related to pain, agitation, and delirium. Most nurses (70%) and physicians (80%) agreed that nurses used good judgment when paging physicians at night because of patients' pain, agitation, and delirium, but physicians (72%) were more likely than nurses (48%) to think that these pages did not portray the situation accurately (P = .004). For many text pages, physicians attributed a heightened level of urgency more often than did the nurses who sent the texts. Nurses often thought that physicians did not appreciate the urgency (33%) or complexity (33%) of the situations the nurses communicated via pages. More physicians (41%) than nurses (14%) agreed that nurses exceeded medication orders for pain, agitation, and delirium before contacting a physician (P = .008). Conclusions Perceptual differences between physicians and nurses about nurse-physician communications at night regarding pain, agitation, and delirium were numerous and should be studied further. (American Journal of Critical Care. 2013;22:e49-e61) Pharmacology in Critical Careby AACN on May 9, 2018 http://ajcc.aacnjournals.org/ Downloaded from because of the fluctuation in pain, agitation, and delirium in critically ill patients, the increased focus on maintaining patients in a light (rather than deep) level of sedation and current recommendations that pain, level of sedation, and delirium be evaluated on a 24/7 basis, the number of issues related to pain, agitation, and delirium that ICU nurses working at night may have to address with the on-call physician most likely has never been greater. [20][21][22] because of these considerations, evaluating communication between ICU nurses and on-call ICU physicians at night about patients' pain, agitation, and delirium provides a good focus for estimating the overall quality of ICU nurse-physician communication at night.Although qualitative research methods are ideal for characterizing the rich, contextual, and likely complex themes that affect communication between nurses and physicians at night, because of the current lack of data on nurse-physician communications at night, we thought that the first step should be a quantitative survey that could serve as the foundation for future qualitative and interventional investigations. [23][24][25] We therefore sought to determine ...

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“…De igual manera que las altas nocturnas en el estudio de Goldfrad y Rowan 8 , las altas no programadas no llevan aparejada mayores tasas de readmisión en UCI. En otros estudios, sin embargo, las altas nocturnas se asocian a más readmisiones 11,[23][24] . Es posible que, en nuestro caso, la mayor edad de los Tabla 3 Características de los tipos de altas con relación a los factores asociados a mortalidad hospitalaria post-UCI…”

Section: Discussionunclassified

Impacto de las altas no programadas en la mortalidad hospitalaria tras la estancia en una unidad de cuidados intensivos

et al. 2011

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ORIGINALImpacto de las altas no programadas en la mortalidad hospitalaria tras la estancia en una unidad de cuidados intensivos ResumenObjetivos: Comprobar la frecuencia de altas no programadas y su relación con la mortalidad hospitalaria tras la estancia en UCI. Diseño: Registro prospectivo de los ingresos de 6 años consecutivos. Análisis retrospectivo de la primera admisión de la cohorte de los supervivientes a UCI. Ámbito: UCI polivalente de 10 camas en hospital general de segundo nivel con 540 camas. Pacientes: 1.521 pacientes con más de 12 horas de estancia, dados de alta vivos y con desenlace hospitalario conocido.Intervenciones: Ninguna. Principales variables de interés: Se registró el tipo de alta de la unidad, normal o no programada, y se exploró su relación con la mortalidad hospitalaria post-UCI, las tasas de readmisión y la estancia hospitalaria post-UCI. Resultados: Hubo 165 altas no programadas (10,8%). La tasa de mortalidad fue del 11,6% (176 pacientes). Los factores relacionados con la mortalidad fueron la limitación del esfuerzo terapéutico (OR = 14,02 [4,6]), las readmisiones (OR = 3,46 [1,78]), las altas no programadas (OR = 2,16 [1,41]), la puntuación de fallos orgánicos al alta de UCI (OR = 1,16 [1,01-1,32]) y la edad (OR = 1,03 [1,01-1,05]). Las readmisiones y las estancias post-UCI no diferían significativamente entre las altas no programadas y las normales (el 7,3 frente al 8,2%; p = 0,68 y 16, 7 ± 16,7 frente a 18,7 ± 21,3 días, respectivamente; p = 0,162). Conclusiones: Las altas no programadas son frecuentes en nuestro medio y contribuyen significativamente a la mortalidad post-UCI, sin que parezcan afectar a otros resultados de la asistencia a pacientes críticos. Impact of the premature discharge on hospital mortality after a stay in an intensive care unit Abstract Objective: To determine the frequency and to evaluate the relationship between premature discharge and post-ICU hospital mortality. Design: A prospective registry was made for patients admitted during six consecutive years, performing a retrospective analysis of the data on the first admission of ICU survivors. Setting: A 10-bed general ICU in a 540-bed tertiary-care community hospital. Patients: 1,521 patients with an ICU stay longer than 12 hours, discharged alive to wards with known hospital outcome. Interventions: None. Main variables:We recorded the patient data, including types of ICU discharge, normal or premature, and studying their relationship with post-ICU hospital mortality. The types of ICU discharge were also evaluated versus ICU readmission rate and post-ICU length of stay. Results: There were 165 patients (10.8%) with premature discharge. Mortality rate was 11.6% (176 patients). The factors related with mortality were withdrawal and limitation of life-sustaining treatments (OR=14. 02 [4.6-42.6 Conclusions: Premature discharges appear to be common in our setting and have a significant impact on mortality. Types of ICU discharge do not seem to be related with other outcome variables in the hospital care of cr...

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The association between nighttime transfer from the intensive care unit and patient outcome*

Abstract: Our study did not find an association between nighttime ICU discharge and hospital mortality. However, the ICU readmission rate was higher and the hospital length of stay longer in the nighttime transfer group.

Cited by 62 publications

References 15 publications

Patient, family and provider experiences with transfers from intensive care unit to hospital ward: a multicentre qualitative study

Patient, family and provider experiences with transfers from intensive care unit to hospital ward: a multicentre qualitative study

Perceptions of Nurses and Physicians of Their Communication at Night About Intensive Care Patients' Pain, Agitation, and Delirium

Impacto de las altas no programadas en la mortalidad hospitalaria tras la estancia en una unidad de cuidados intensivos

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