The following article is a part of conference coverage from the 2021 American Association of Nurse Practitioners National Conference (AANP 2021), held virtually from June 15 to June 20, 2021. The team at the Clinical Advisor will be reporting on the latest news and research conducted by leading NPs. Check back for more from AANP 2021.
A nurse practitioner-led critical care outreach and monitoring program showed efficacy in identifying hospitalized patients at high risk for unplanned intensive care unit (ICU) readmissions, according to research presented in a poster session at the 2021 American Association of Nurse Practitioners National Conference (AANP 2021).
Critical care unit unplanned readmissions are associated with increased mortality risk and length of hospital stay. Care coordination can improve patient outcomes by providing support and continuity during this time of transition.
In a retrospective study, Jessica Peters, DNP, MS, RN, ACNP and Valerie Elliott, MSN, RN, ACNP, CRNP, of the Weinberg Intensive Care Unit Advanced Practice Group at The Johns Hopkins Hospital in Baltimore, Maryland, sought to identify characteristics in surgical patients that are associated with prolonged critical care. The researchers also aimed to improve their understanding of patients who were deemed of clinical concern for decompensation and to determine if the appropriate patients were selected for outreach and evaluation.
The study cohort included 166 patients considered at high risk for unplanned readmissions who were transitioning from a single surgical critical care unit to the floor in a large, urban, teaching medical institution. Eleven advanced nurse practitioners administered the following interventions within the 20-bed surgical ICU:
- Handoff tool: an electronic note relaying pertinent patient care information
- Outreach algorithm: patients were evaluated every 12 hours after transition from the ICU for up to 48 hours
Data were also randomly collected and retrospectively reviewed in a comparison group of 122 patients who were not enrolled in the intervention.
The rate of unplanned ICU admissions was higher among patients enrolled in the intervention program than among nonenrolled patients (35% vs 9%), suggesting that that the providers were successful in identifying high-risk patients. The enrolled group had a higher 14% mortality rate (vs 7% in the nonenrolled group) and higher rates of blood transfusion requirements, prolonged intubation time, arrhythmia, hemodynamic instability, and aggressive diuresis.
Table. Results Among Patients Enrolled vs Not Enrolled in an ICU Transition Intervention
|Outcome||Enrolled Group (n=166)||Nonenrolled group (n=122)|
|Blood transfusion requirements||52%||26%|
|Prolonged intubation time||50%||20%|
A statistically significant correlation between in-hospital mortality and unplanned readmission was found among patients enrolled in the intervention (P <0.05) but not in the unenrolled group. The following complications were significantly associated with unplanned ICU readmissions: need for airway clearance, bacteremia, aggressive diuresis, and pulmonary embolism.
Critical care providers were successful at identifying patient at high risk for unplanned readmission and who experienced a complicated ICU course, the presenters said. Further research on targeted interventions to reduce ICU readmissions among high-risk patients are needed, the study authors concluded.
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Peters J, Elliott V. Nurse practitioner directed identification and provision of transition care for medically complex patients. Poster presented at: 2021 American Association of Nurse Practitioners National Conference (AANP 2021); June 15-20, 2021. Poster 75.