Key result
Critical care transition programs modestly reduced the risk of readmission (RR 0.78; 95% CI 0.64-0.96) but not in-hospital mortality, with very low certainty of evidence.
Why the study?
Deterioration after ICU discharge may cause readmission or death, prompting critical care transition programs whose impact on these outcomes needed assessment.
Do critical care transition programs reduce readmission or death in adults discharged from the ICU?
Meta-Analysis
Do critical care transition programs reduce readmission or death in adults discharged from the ICU?
Relative Risk: 0.78 (95% CI 0.64–0.96)
Critical care transition programs do not have firm evidence of reducing readmission or death after ICU discharge due to very low quality of available studies.
Critical care transition programs lack firm evidence of benefit; low-quality data leave efficacy uncertain pending RCTs.
BACKGROUND: Deterioration after ICU discharge may lead to readmission or even death. Interventions (eg, critical care transition programs) have been developed to improve the clinical handover between the ICU and the ward. We conducted a systematic review with meta-analysis and trial sequential analysis (TSA) according to Cochrane Handbook and Grading of recommendations, assessment, development and evaluations (GRADE) methodology to assess the impact of these interventions on readmission and death (PROSPERO, no CRD42019121746). METHODS: We searched PubMed/MEDLINE, CINAHL, AMED, PsycINFO, and the Cochrane Central Register for Controlled Trials from inception until January 2019. We included historically controlled studies that evaluated critical care transition programs in adults discharged from the ICU. Readmission and in-hospital mortality were the primary outcomes. Risk of bias, publications bias, and the quality of evidence were assessed with the ROBINS-Itool, funnel plot and GRADE, respectively. RESULTS: Fifteen observational studies were included (11 in meta-analysis). All studies had at least serious risk of bias. ICU discharge within a critical care transition program modestly reduced the risk of readmission (RR 0.78; 95% CI: 0.64-0.96; TSA-adjusted 95% CI: 0.59-1.03) but not in-hospital mortality (RR 0.82; 95% CI: 0.64-1.06; TSA-adjusted 95% CI: 0.49-1.37). There was substantial heterogeneity among studies. TSA indicated lack of firm evidence. The GRADE quality of evidence on outcomes was very low. CONCLUSIONS: We found no clear benefit in terms of reducing risk of readmission or death after ICU discharge, however, with overall very low certainty of evidence.
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Österlind et al. (2020) conducted a meta-analysis in Adults discharged from the ICU. Critical care transition programs vs. Historical controls was evaluated on Readmission (RR 0.78, 95% CI 0.64-0.96). Critical care transition programs modestly reduced the risk of readmission (RR 0.78; 95% CI 0.64-0.96) but not in-hospital mortality, with very low certainty of evidence.
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