• Teresa Ann Williams, Gavin Leslie, Judith Finn, Linda Brearley, Mariyam Asthifa, Ben Hay, Karen Laurie, Tim Leen, Keith O'Brien, Michael Stuart, and Michelle Watt.
• Critical Care Division at Royal Perth Hospital in Perth, Western Australia. Teresa.Williams@health.wa.gov.au
• Am. J. Crit. Care. 2010 Sep 1; 19 (5): e63-72.

BackgroundImproved discharge planning and extension of care to the general care unit for patients transferring from intensive care may prevent readmission to the intensive care unit and prolonged hospital stays. Morbidity, mortality, and costs increase in readmitted intensive care patients.ObjectivesTo evaluate the clinical effectiveness of a critical care nursing outreach service in facilitating discharge from the intensive care unit and providing follow-up in general care areas.MethodsA before-and-after study design (with historical controls and a 6-month prospective intervention) was used to ascertain differences in clinical outcomes, length of stay, and cost/benefit. Patients admitted to intensive care units in 3 adult teaching hospitals were recruited. The service centered on follow-up visits by specialist intensive care nurses who reviewed and assessed patients who were to be or had been discharged to general care areas from the intensive care unit. Those nurses also provided education and clinical support to staff in general care areas.ResultsIn total, 1435 patients were discharged during the 6-month prospective period. Length of stay from the time of admission to the intensive care unit to hospital discharge (P = .85), readmissions during the same hospital admission (5.6% vs 5.4%, P = .83), and hospital survival (P = .80) did not differ from before to after the intervention.ConclusionsAlthough other studies have shown beneficial outcomes in Australia and the United Kingdom, we found no improvement in length of stay after admission to the intensive care unit, readmission rate, or hospital mortality after a critical care nursing outreach service was implemented.

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