Uptake and caseload of intensive care unit liaison nurse services in Australia

Background: Intensive care unit liaison nurses (ICULNs) represent a new clinical service role in the Australian health care system. These nurses aim to improve patient outcomes by providing a specialised support service to ward staff caring for acutely ill patients. As this role is relatively new, it is not known how many hospitals employ ICULNs or what the demand for their services is. Objectives: We aimed to identify the number of hospitals in the Australian College of Critical Care Nurses ICULN special interest group that report having an ICULN service, to document the timing of their introduction, and to assess changes in caseload since introduction. Design and setting: We conducted a retrospective observational study of the changes in ICULN operating hours and monthly patient reviews, and the timing of implementation of the services in Australian hospitals. We also assessed aspects of the ethics submission and approval process. Results: Seventeen Australian hospitals submitted data. Before 2004, there were only two ICULN services. The number of services dramatically increased between 2004 and 2007. In 14 sites, monthly patient reviews increased by a median of 54.3%. After adjustment for staff hours, 10 hospitals reported an increase in monthly patient reviews (median increase, 48.8%). Between 1999 and 2011, the 17 services performed 123 236 patient reviews, including 73 022 ICU discharges (59.3%), 26 800 during or after rapid response team review (21.7%), and 23 414 de-novo referrals from ward staff (19.0%). Conclusion: The demand for ICULN services has increased in most hospitals since the role was adopted, although this varies considerably. The majority of patients are reviewed after ICU discharge. Further research is needed to define the scope of practice of the role and its impact on patient outcome, particularly in patients after ICU discharge.