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American Journal of Critical Care. 2008;17: 255-263
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CE Article

Predictors of Adverse Events in Patients After Discharge From the Intensive Care Unit

By Wendy Chaboyer, RN, PhD, Lukman Thalib, PhD, Michelle Foster, RN, MN, Carol Ball, RN, PhD and Brent Richards, MD. Wendy Chaboyer is a professor and director of the Research Centre for Clinical and Community Practice Innovation, Griffith University Gold Coast Campus, Queensland, Australia. Lukman Thalib is an associate professor in the Faculty of Medicine at the University of Kuwait, Safat, and is an adjunct professor with the Research Centre for Clinical and Community Practice Innovation, Griffith University Gold Coast Campus, Queensland, Australia. Michelle Foster is the nurse unit manager of the intensive care unit at Gold Coast Hospital in Southport, Queensland, Australia. Carol Ball is a consultant nurse in critical care at Royal Free Hospital in London, England. Brent Richards is the executive director of the Division of Surgery and Critical Care at Gold Coast Hospital in Southport, Queensland, Australia.

Corresponding author: Wendy Chaboyer, RN, PhD, Research Centre for Clinical and Community Practice Innovation, Griffith University Gold Coast Campus, Queensland, 4222 Australia (e-mail: W.Chaboyer{at}griffith.edu.au).

Background Patients discharged from the intensive care unit may be at risk of adverse events because of complex care needs.

Objective To identify the types, frequency, and predictors of adverse events that occur in the 72 hours after discharge from an intensive care unit when no evidence of adverse events was apparent before discharge.

Methods A predictive cohort study of 300 patients from an adult intensive care unit was undertaken. An internationally accepted protocol for chart audit was used. Frequency of adverse events was calculated, and logistic regression was used to determine independent predictors of adverse events.

Results A total of 147 adverse events, 17 (11.6%) of which were defined as major, were incurred by 92 patients (30.7%). The 3 most common adverse events, hospital-incurred infection or sepsis (n = 32, 21.8%), hospital-incurred accident or injury (n = 17, 11.6%), and other complication such as deep vein thrombosis, pulmonary edema, or myocardial infarction (n = 17, 11.6%) accounted for 44.9% (n = 66) of all adverse events. Two predictors, respiratory rate less than 10/min or greater than or equal to 25/min and pulse rate exceeding 110/min, were significant independent predictors; requiring a high level of nursing care at the time of discharge was a significant predictor in univariate analysis but not in multivariate analysis.

Conclusion Taking, recording, and reporting vital signs are important. Nursing care requirements of patients at discharge from the intensive care unit may be worthy of further investigation in studies of patients after discharge.

Notice to CE enrollees:
A closed-book, multiple-choice examination following this article tests your understanding of the following objectives:
  1. Identify adverse events related to discharge from the intensive care unit (ICU)
  2. Describe tools used to monitor adverse events in patients discharged from the ICU
  3. Establish protocols and follow-up chart audits for patients discharged from the ICU
To read this article and take the CE test online, visit www.ajcconline.org and click "CE Articles in This Issue." No CE test fee for AACN members.






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