Journal article
Problems in care and avoidability of death after discharge from intensive care: a multi-centre retrospective case record review study
- Abstract:
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Background: Over 138,000 patients are discharged to hospital wards from Intensive Care Units (ICUs) in England, Wales and Northern Ireland annually. More than 8,000 die before leaving hospital. In hospital-wide populations, 6.7-18% of deaths have some degree of avoidability. For patients discharged from ICU, neither the proportion of avoidable deaths nor the reasons underlying avoidability have been determined.
We undertook a retrospective case record review within the REFLECT study, examining how post-ICU ward care might be improved.
Methods: A multi-centre retrospective case record review of 300 consecutive post-ICU in-hospital deaths, between January 2015 and March 2018, in 3 English hospitals. Trained multi professional researchers assessed the degree to which each death was avoidable and determined care problems using the established Structured Judgement Review method.
Results: Agreement between reviewers was good (weighted kappa 0.77, 95% CI 0.64-0.88). Discharge from an ICU for end-of-life care occurred in 50/300 patients. Of the remaining 250 patients, death was probably avoidable in 20 (8%, 95% CI 5.0-12.1) and had some degree of avoidability in 65 (26%, 95% CI 20.7-31.9). Common problems included out-of-hours discharge from ICU (168/250, 67.2%), suboptimal rehabilitation (167/241, 69.3%), absent nutritional planning (76/185, 41.1%) and incomplete sepsis management (50/150, 33.3%).
Conclusions: The proportion of deaths in hospital with some degree of avoidability is higher in patients discharged from an ICU than reported in hospital-wide populations. Extrapolating our findings suggests around 550 probably avoidable deaths occur annually in hospital following ICU discharge in England, Wales and Northern Ireland. This avoidability occurs in an elderly frail population with complex needs that current strategies struggle to meet. Problems in post-ICU care are rectifiable but multi-disciplinary.
- Publication status:
- Published
- Peer review status:
- Peer reviewed
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(Preview, Version of record, 767.2KB, Terms of use)
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- Publisher copy:
- 10.1186/s13054-020-03420-5
Authors
- Publisher:
- BMC
- Journal:
- Critical Care More from this journal
- Volume:
- 25
- Issue:
- 2021
- Article number:
- 10
- Publication date:
- 2021-01-06
- Acceptance date:
- 2020-11-29
- DOI:
- EISSN:
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1875-7081
- ISSN:
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1364-8535
- Language:
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English
- Keywords:
- Pubs id:
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1149982
- Local pid:
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pubs:1149982
- Deposit date:
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2020-12-17
Terms of use
- Copyright holder:
- Vollam et al.
- Copyright date:
- 2021
- Rights statement:
- © The Author(s) 2021. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativeco mmons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
- Licence:
- CC Attribution (CC BY)
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