Introduction and objectives Optimal utilisation of critical care resources requires timely discharge of patients from critical care to appropriate wards. This represents a challenging and high risk transition. Local audits revealed that a few multimorbid patients with difficult respiratory weans accounted for 30% of critical care bed days. A weekly ventilation multidisciplinary team (VMDT) meeting combining respiratory and critical care expertise was established at a 692-bed hospital to improve management and resource use for this patient group. The effect was compared to a 2nd hospital within the same trust without VMDT.
Method A retrospective comparison of 6 month periods before (period 1: 1/10/07–31/3/08) and after (period 2: 1/10/12–31/3/13) introducing VMDT was carried out using data collected for Intensive Care National Audit and Research Centre. The same data was collected for a sister hospital, belonging to the same trust, without VMDT. The numbers of discharges to a respiratory ward with non- invasive ventilation (NIV) facilities were compared with Chi-Square test. The numbers of level 1 critical care bed days were compared with T test.
Results In period 1, hospital 1 discharged 458 patients from critical care and hospital 2 discharged 456. In period 2 these figures were 494 (p = 0.30) and 495 (p = 0.84) respectively. There was no change to background parameters. The number of discharges to respiratory ward with NIV facilities increased significantly in hospital 1 (36 to 65, p = 0,011) after VMDT. Whilst the number of patients discharged to respiratory ward increased in hospital 2 this was not significant (9 to 19, p = 0.13). The number of level 1 bed days fell significantly (208 to 18, p < 0.0000000001) in hospital 1. Hospital 2 saw an increase in level 1 days over the same period.
Conclusion Introduction of VMDT increased the proportion of respiratory patients discharged to a respiratory ward from critical care and reduced level one bed days in hospital 1 by expediting the discharge of complex respiratory wean patients thereby increasing patient flow and liberating critical care resources. The same reduction was not observed in the hospital 2 suggesting this effect was not due to trust wide changes in critical care practice.
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