Data from: 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 United Kingdom

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 incorporating an adjusted risk score was introduced. The prospective cohort underwent risk scoring at ICU discharge and inpatient review using the PIRT. Outcomes: The primary outcome was the composite of death or readmission to ICU within 14 days of ICU discharge following the index ICU admission. Results: PIRT review was achieved for 67.3% of all eligible discharges and improved the targeting of acute post-ICU review to high risk patients. The presence of ward-based PIRT review in the prospective cohort did not correlate with a reduction in poor outcome overall (p = 0.876) or overall readmission but did reduce early readmission (within the first 48 hours) from 4.5% to 3.6% (p = 0.039), while increasing the rate of late readmission (48 hours to 14 days) from 2.7% to 5.8% (p = 0.046). Conclusion: PIRT facilitates the appropriate targeting of nurse-led inpatient review acutely after ICU discharge but does not reduce hospital mortality or overall readmission rates to ICU.研究目标：基于大型观察性数据集构建重症监护病房（Intensive Care Unit, ICU）出院后不良预后的临床预测模型，并将其与急性ICU后病房评估工具（Post-ICU Review Tool, 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与预后结局。 研究设计：回顾性患者队列纳入2006年6月至2011年10月期间的首次ICU住院患者，所有受试者均接受常规住院评估；前瞻性队列纳入2012年3月至2013年3月的患者，采用PIRT进行风险评分，以此指导后续住院病房评估工作。 研究场景：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计4212例符合入组标准的ICU出院患者，前瞻性干预队列则纳入1028例患者。 干预措施：对回顾性队列开展多因素分析，明确与不良预后相关的影响因素，据此构建出院风险评分模型；随后引入整合调整后风险评分的出院及每日病房评估工具。前瞻性队列患者在ICU出院时接受PIRT风险评分，并依此开展住院病房评估。 研究结局：主要结局为首次ICU住院患者在ICU出院后14天内的复合终点，包括死亡或ICU再入院。 研究结果：所有符合入组标准的出院患者中，67.3%完成了PIRT评估，该工具可更精准地将急性ICU后病房评估靶向对准高危人群。在前瞻性队列中，实施病房PIRT评估并未显著降低整体不良预后发生率（p=0.876）及总体ICU再入院率，但可将早期再入院（出院后48小时内）发生率从4.5%降至3.6%（p=0.039），同时将晚期再入院（出院后48小时至14天）发生率从2.7%提升至5.8%（p=0.046）。 研究结论：PIRT可助力ICU出院后急性期由护士主导的住院评估的精准靶向实施，但未能降低住院死亡率或总体ICU再入院率。