The impact of an ICU liaison nurse service on patient outcomes

Abstract

Objective: To determine the effect an intensive care unit liaison nurse service had on ICU patient discharges, readmissions and outcomes.

Methods: We evaluated the impact of our ICU liaison nurse service in a 36-month before-and-after study on ICU and hospital length of stay (LOS) and mortality, and ICU step-down days (time spent in ICU in a 1 : 2 nurse to patient ratio).

Results: There was a 13% increase in patient throughput after the introduction of the ICU liaison nurse service (835 ICU admissions in the 18 months before v 943 in the 18 months after). Despite trends to an improvement, there was no significant change in median ICU LOS (2.2 days before v 2.1 days after) or median hospital LOS (12.0 days before v 11.5 days after), or in ICU or hospital mortality (ICU, 15% before v 14% after; hospital, 23% before v 22% after). ICU step-down days were significantly decreased by 48% (71 +/- 14.2 days v 37 +/- 15.5 days; P < 0.001). In the patient group readmitted to the ICU (49 patients before v 55 patients after), there was a 25% (1 day) decrease in median ICU LOS (4.0 v 3.0 days), and a trend to decreased mortality in both the ICU (18% before v 16% after) and hospital (35% before v 26% after).

Conclusions: The introduction of our ICU liaison nurse service was associated with a trend towards more efficient ICU discharges (increased throughput, decreased ICU step-down days and ICU readmission LOS) and improved survival for ICU patients requiring readmission, but overall ICU and hospital LOS and mortality, and ICU readmission rates were unchanged.