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Direct transfer of long-stay ICU patients to a nursing-home rehabilitation unit: focus on functional dependency.

Vossenberg-Postma SR, Sikkema YT, Drogt-Bilaseschi I, Bruins-Lange NA, de Jager CM, van Maaren T, van der Pol V, Boerma EC - Intensive Care Med (2015)

View Article: PubMed Central - PubMed

Affiliation: Elderly Care Medicine, Zorggroep Noorderbreedte, Leeuwarden, The Netherlands.

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Patients with an ICU length of stay (LOS) longer than 48 h, a hospital ward as first post-ICU step-down unit and an NRU as final destination were selected (indirect transfer group, ITG)... In the second phase, after an intervention to redirect patient flow, patients with an ICU LOS longer than 48 h and a direct transfer to an NRU were prospectively included (direct transfer group, DTG)... In a 5-year period we included 31 patients in the ITG and 24 patients in the DTG, representing 0.7 % of the total ICU population... At ICU discharge BI did not differ between groups [data are presented as median (IQR); ITG 2 (0–2) vs... DTG 2 (1–6), p = 0.15]... Severity of illness, days of mechanical ventilation and LOS ICU were significantly higher in the DTG (ESM)... Primary endpoint, the BI at NRU discharge, was not different between groups [ITG 16 (14–18) vs... DTG 46 (19–117), p = 0.03; Fig.  1]... In addition, hospital readmission rates, mortality and final discharge status did not differ between groups (ESM)... Our data suggest that an NRU as the first post-ICU step-down facility in functionally dependent patients may be associated with equal functional outcome in a shorter time frame, as compared to the traditional pathway... We hope this may fuel initiatives to focus on functional rather than medico-technical support in this specific group of long-stay ICU patients... Supplementary material 1 (DOCX 25 kb)

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Functional dependency at discharge ICU and rehab before and after intervention in the step-down destination post ICU
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Fig1: Functional dependency at discharge ICU and rehab before and after intervention in the step-down destination post ICU

Mentions: In a 5-year period we included 31 patients in the ITG and 24 patients in the DTG, representing 0.7 % of the total ICU population. At ICU discharge BI did not differ between groups [data are presented as median (IQR); ITG 2 (0–2) vs. DTG 2 (1–6), p = 0.15]. Severity of illness, days of mechanical ventilation and LOS ICU were significantly higher in the DTG (ESM). Primary endpoint, the BI at NRU discharge, was not different between groups [ITG 16 (14–18) vs. DTG 16 (11–18), p = 0.50; Fig. 1]. However, LOS post ICU was significantly longer in the ITG [ITG 74 (58–106) vs. DTG 46 (19–117), p = 0.03; Fig. 1]. In addition, hospital readmission rates, mortality and final discharge status did not differ between groups (ESM).Fig. 1


Direct transfer of long-stay ICU patients to a nursing-home rehabilitation unit: focus on functional dependency.

Vossenberg-Postma SR, Sikkema YT, Drogt-Bilaseschi I, Bruins-Lange NA, de Jager CM, van Maaren T, van der Pol V, Boerma EC - Intensive Care Med (2015)

Functional dependency at discharge ICU and rehab before and after intervention in the step-down destination post ICU
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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getmorefigures.php?uid=PMC4582074&req=5

Fig1: Functional dependency at discharge ICU and rehab before and after intervention in the step-down destination post ICU
Mentions: In a 5-year period we included 31 patients in the ITG and 24 patients in the DTG, representing 0.7 % of the total ICU population. At ICU discharge BI did not differ between groups [data are presented as median (IQR); ITG 2 (0–2) vs. DTG 2 (1–6), p = 0.15]. Severity of illness, days of mechanical ventilation and LOS ICU were significantly higher in the DTG (ESM). Primary endpoint, the BI at NRU discharge, was not different between groups [ITG 16 (14–18) vs. DTG 16 (11–18), p = 0.50; Fig. 1]. However, LOS post ICU was significantly longer in the ITG [ITG 74 (58–106) vs. DTG 46 (19–117), p = 0.03; Fig. 1]. In addition, hospital readmission rates, mortality and final discharge status did not differ between groups (ESM).Fig. 1

View Article: PubMed Central - PubMed

Affiliation: Elderly Care Medicine, Zorggroep Noorderbreedte, Leeuwarden, The Netherlands.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Patients with an ICU length of stay (LOS) longer than 48 h, a hospital ward as first post-ICU step-down unit and an NRU as final destination were selected (indirect transfer group, ITG)... In the second phase, after an intervention to redirect patient flow, patients with an ICU LOS longer than 48 h and a direct transfer to an NRU were prospectively included (direct transfer group, DTG)... In a 5-year period we included 31 patients in the ITG and 24 patients in the DTG, representing 0.7 % of the total ICU population... At ICU discharge BI did not differ between groups [data are presented as median (IQR); ITG 2 (0–2) vs... DTG 2 (1–6), p = 0.15]... Severity of illness, days of mechanical ventilation and LOS ICU were significantly higher in the DTG (ESM)... Primary endpoint, the BI at NRU discharge, was not different between groups [ITG 16 (14–18) vs... DTG 46 (19–117), p = 0.03; Fig.  1]... In addition, hospital readmission rates, mortality and final discharge status did not differ between groups (ESM)... Our data suggest that an NRU as the first post-ICU step-down facility in functionally dependent patients may be associated with equal functional outcome in a shorter time frame, as compared to the traditional pathway... We hope this may fuel initiatives to focus on functional rather than medico-technical support in this specific group of long-stay ICU patients... Supplementary material 1 (DOCX 25 kb)

No MeSH data available.