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Reducing night-time discharge from intensive care. A nationwide improvement project with public display of ICU outcomes
Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences. Uppsala Univ, Sweden; Gavle Cent Hosp, Sweden.
Swedish Intens Care Registry, Sweden.
Cent Hosp Kristianstad, Sweden.
Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences.
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2019 (English)In: Journal of critical care, ISSN 0883-9441, E-ISSN 1557-8615, Vol. 49Article in journal (Refereed) Published
Abstract [en]

Purpose: Discharge from an intensive care unit (ICU) during the night is an independent risk factor for adverse outcomes. A quality improvement project was conducted with the aim of reducing the incidence and the associated mortality after night-time discharge. Materials and methods: ICUs that submitted data to the Swedish Intensive Care Registry (SIR) agreed to appoint night-time discharge as a national quality indicator with detailed public display on the internet of various discharge proportions and outcomes. The registry was then examined for trends during a 10-year period with use of multilevel mixed-effects models. Results: We analysed 163,371 patients who were discharged alive from 70 ICUs to a general ward within the same hospital during 2006-2015. The prevalence of night-time discharge fell from 7.0% (95% CI: 52 to 8.7%) in 2006 to 4.9% (95% CI: 43 to 5.5%) in 2015 (P = .035 for trend). The original increased risk of death within 30 days after night-time discharge in 2006-2010, OR 1.20 (95% CI: 1.01 to 1.42), disappeared in 2011-2015, OR 1.06 (95% CI: 0.96 to 1.17). Conclusions: During the 10-year period of the quality improvement project, the annual prevalence and risk of death within 30-days after night-time discharge were reduced. The public display and feedback of audit data could have helped in achieving this. (C) 2018 Elsevier Inc. All rights reserved.

Place, publisher, year, edition, pages
W B SAUNDERS CO-ELSEVIER INC , 2019. Vol. 49
Keywords [en]
Intensive Care; Critical Care; Auditing; Quality improvement; Critical Care Management; Outcome study
National Category
Anesthesiology and Intensive Care
Identifiers
URN: urn:nbn:se:liu:diva-153492DOI: 10.1016/j.jcrc.2018.09.022ISI: 000451728600002PubMedID: 30336358OAI: oai:DiVA.org:liu-153492DiVA, id: diva2:1274660
Available from: 2019-01-02 Created: 2019-01-02 Last updated: 2019-01-02

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Parenmark, FredricFredrikson, MatsWalther, Sten
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Department of Medical and Health SciencesFaculty of Medicine and Health SciencesDivision of Neuro and Inflammation ScienceDivision of Cardiovascular MedicineDepartment of Thoracic and Vascular Surgery
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