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

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.