Establishment of A Respiratory Assessment Team is Associated with Decreased Mortality in Patients Re-Admitted to the Icu

Abstract

Within an institution, opportunities exist to improve the appropriateness, continuity, and consistency of respiratory care services. We had the opportunity to observe differences in ICU patient outcome associated with improving the quality and appropriateness of respiratory care delivered to non-ICU patients on acute hospital floors. After treatment for a critical illness, some patients may be re-admitted to an intensive care unit (ICU) due to respiratory deterioration. ICU re-admission carries a high risk of death. We studied outcomes in a group of patients re-admitted to an ICU before the practice of assessing patients by a dedicated respiratory therapy assessment team had been established and outcomes in a group admitted several years after that practice had been put in place. We found that neither the overall ICU re-admission rate (4.7% vs 4.8% p = 0.81) nor the percentage of patients re-admitted for respiratory failure (43% vs 54%, p = 0.23) had changed. However, a highly significant decrease in mortality for the re-admitted patients (12% vs 41%, p <0.0001) and in the proportion re-admitted for respiratory failure (19% vs 47%, p < 0.0001) was seen. Reduction in premature discharge (early triage) did not seem to contribute to the improvement because the initial ICU length of stay remained unchanged and the same percentage was re-admitted for worsening of the original problem as for development of a new problem (45% vs 40%, p = 0.562, χβ). We believe that better patient assessment and treatment outside the ICU, due to the establishment of a respiratory therapy assessment team, resulted in earlier identification of developing problems and more rapid ICU re-admission, and may have contributed to the reduced mortality observed. [Respir Care 1996;41(10):903-907]