Does the implementation of a novel intensive care discharge risk score and nurse-led inpatient review tool improve outcome? A prospective cohort study in two intensive care units in the UK

Objective: To develop a clinical prediction model for poor outcome after ICU discharge in a large observational dataset and couple this to an acute post-ICU ward-based review tool (PIRT) to identify high-risk patients at the time of ICU discharge and improve their acute ward-based review and outcome. Design: Retrospective patient cohort of index ICU admissions between June 2006 and October 2011 receiving routine inpatient review. Prospective cohort between March 2012 and March 2013 underwent risk scoring (PIRT) which subsequently guided inpatient ward-based review. Setting: Two UK adult intensive care units. Participants: 4,212 eligible discharges from ICU in the retrospective development cohort and 1,028 patients included in the prospective intervention cohort. Interventions: Multivariate analysis was performed to determine factors associated with poor outcome in the retrospective cohort and used to generate a discharge risk score. A discharge and daily ward-based review tool incor...研究目标：基于大型观察性数据集，开发重症监护病房（Intensive Care Unit，ICU）出院后不良预后的临床预测模型，并将该模型与急性ICU后病房评估工具（acute post-ICU ward-based review tool，简称PIRT）相结合，以在ICU出院时识别高危患者，优化其急性病房评估流程并改善预后。 研究设计：回顾性患者队列纳入2006年6月至2011年10月期间接受常规住院评估的首次ICU收治病例；前瞻性队列纳入2012年3月至2013年3月的患者，对其实施风险评分（即前述PIRT工具），该评分后续用于指导病房住院评估。 研究场所：英国两家成人重症监护病房。 研究对象：回顾性开发队列中共纳入4212例符合入组标准的ICU出院患者，前瞻性干预队列中共纳入1028例患者。 干预措施：对回顾性队列开展多因素分析，以明确与不良预后相关的影响因素，并据此构建出院风险评分模型。同时开发了出院及每日病房评估工具……