Out-of-hours discharge from intensive care is strongly associated with both in-hospital death and ICU readmission, according to a study supported by the NIHR Oxford Biomedical Research Centre.
The systematic review and meta-analysis by researchers from the University of Oxford’s Nuffield Department of Clinical Neurosciences and the Kadoorie Centre, based at the John Radcliffe Hospital, covered 18 studies from around the world.
The research was prompted by statistics showing that one in 12 patients discharged from an intensive care unit (ICU) die unexpectedly on general wards before leaving hospital. This high death rate occurs despite hospitals using ‘early warning’ scoring systems and visits from ICU teams.
Transferring patients from ICU to hospital wards sometimes happens overnight, when there are fewer staff on the wards.
Analysis of data showed a strong link between being discharged at night and death or readmission to intensive care.
These effects remained across all definitions of out-of-hours and across healthcare systems in different geographical locations. Whether these increases in mortality and readmission result from patient differences, differences in care, or a combination remains unclear.
The study was part of the REFLECT research programme, which is reviewing the care of patients after they have been discharged from intensive care. This programme will provide an in-depth picture of post-ICU ward management in three NHS trusts.
The findings from the project will help researchers and practitioners work together to improve post-ICU patient outcome. This could include reducing out-of-hours discharge, or at least acknowledging it as suboptimal, and putting in place measures that would support patients on the ward.