Characteristics and outcomes of patients subject to intensive care nurse consultant review in a teaching hospital

Objective: To describe the evolution of our Intensive Care Nurse Consultant (ICNC) service, the characteristics and outcomes of the patients reviewed, and interventions performed. Design, setting and participants: Retrospective observational study in a tertiary referral university-affiliated teaching hospital among all patients reviewed by the ICNC service between September 2007 and December 2009. Main outcome measures: Number and characteristics of patients reviewed, source of referral, interventions performed, inhospital mortality and hospital length of stay. Results: Since August 2006, operating hours have increased and provision has been made for senior ICU nurses to undertake 6-month developmental allocations to the role. The name of the service was changed and a weekly report was commenced to capture patient referral source, and subsequent ICU medical referral. Additional changes included provision of an administration day, and use of an ICU discharge scoring tool. A total of 3118 (2278 post-ICU and 840 non-ICU) care episodes were provided by the ICNC service between September 2007 and December 2009. Median patient age was 64 years, inhospital mortality was about 9 and most reviews occurred in surgical patients and after ICU discharge. Most new ward referrals came from an ICU doctor or ward nurse, with few referrals from ward doctors. Communication with ward nurses was more common than with ward doctors. A common recommendation involved fluid and electrolyte management. In-hospital mortality was higher among patients entering the service after review by a medical emergency team or de-novo referral than in patients after ICU discharge. Conclusions: Most interventions are relatively simple, and the ICNC role may be augmented by limited rights to prescribe electrolyte replacement. The effect of the intervention on patient outcomes and the reproducibility of our findings in other hospitals remain to be determined.