Journal of Critical Care
Volume 25, Issue 2 , Pages 196-204, June 2010

The effects of critical care outreach services before and after critical care: A matched-cohort analysis☆

  • David A. Harrison, PhD

      Affiliations

    • Intensive Care National Audit & Research Centre, Tavistock House, Tavistock Square, London WC1H 9HR, UK
    • Corresponding Author InformationCorresponding author. Tel.: +44 20 7388 2856; fax: +44 20 7388 3759.
    • ,
  • Haiyan Gao, PhD

      Affiliations

    • Intensive Care National Audit & Research Centre, Tavistock House, Tavistock Square, London WC1H 9HR, UK
    • Current affiliation: National Institute of Clinical Outcomes Research, University College London, Suite 501, Heart Hospital, Westmoreland Street, London W1G 8PH, UK
    • ,
  • Catherine A. Welch, MSc

      Affiliations

    • Intensive Care National Audit & Research Centre, Tavistock House, Tavistock Square, London WC1H 9HR, UK
    • ,
  • Kathryn M. Rowan, DPhil

      Affiliations

    • Intensive Care National Audit & Research Centre, Tavistock House, Tavistock Square, London WC1H 9HR, UK

Abstract 

Purpose

The purpose of the study was to evaluate the effect of visits from critical care outreach services (CCOS) before admission to and following discharge from critical care.

Materials and Methods

A cohort study was performed in 52 acute hospitals in England. A total of 23 234 patients received CCOS visits; 10 404 (45%) were admitted to a critical care unit, and 7078 (68%) were included in the analysis. Patients receiving CCOS visits before (n = 2203) and after (n = 5924) critical care were matched 1:1 to 3 control pools: historical admissions to the same unit before introduction of CCOS, admissions to a unit in a hospital with no CCOS, and contemporary admissions to the same unit not receiving CCOS visits. Matching was based on individual factors and on propensity.

Results

The CCOS visits preadmission were not associated with differences in severity of illness, but were associated with lower rates of cardiopulmonary resuscitation, longer prior hospital stay, and longer unit stay. The CCOS visits postdischarge were associated with lower hospital mortality and shorter hospital stay in 2 matches, but not when compared with contemporary admissions to the same unit.

Conclusions

Our results suggest a benefit to scheduled follow-up visits of patients discharged from critical care. Results for CCOS before critical care are inconclusive.

Keywords: Cohort studies, Critical care, Delivery of health care, Emergency medical services, Organization and administration

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☆ All work was carried out at the Intensive Care National Audit & Research Centre, London, United Kingdom.

PII: S0883-9441(10)00119-X

doi:10.1016/j.jcrc.2009.12.015

Journal of Critical Care
Volume 25, Issue 2 , Pages 196-204, June 2010

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