ArticleCritical care explorations2020
The Impact of Step-Down Unit Care on Patient Outcomes After ICU Discharge.
Article in Critical care explorations, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.
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Who cites it
10 citing papers in PubMed.
- Outcomes of patients with hypertensive emergency managed in intensive vs intermediate care settings: a multihospital retrospective cohort study.Annals of the American Thoracic Society · 2026Observational
- Article
- Outcomes and cost-effectiveness of intermediate care units for patients discharged from the intensive care unit: a nationwide retrospective observational study.Critical care (London, England) · 2025Observational
- Machine Learning Identification of Modifiable Predictors of Patient Outcomes After Transcatheter Aortic Valve Replacement.JACC. Advances · 2024Article
- The Role of Intermediate Care in Supporting Critically Ill Patients and Critical Care Infrastructure.Critical care clinics · 2024Review
- Evaluation of veteran community care outcomes after coronary artery bypass grafting: a retrospective pilot cohort.Journal of cardiothoracic surgery · 2024Article
- [A clinical study of high dependency units to reduce ICU readmission rates in patients with severe liver disease].Zhonghua gan zang bing za zhi = Zhonghua ganzangbing zazhi = Chinese journal of hepatology · 2023Article
- Development of a Medium Care Unit Using an Inexperienced Respiratory Staff: Lessons Learned during the COVID-19 Pandemic.International journal of environmental research and public health · 2022Article
- The Austrian ICU survey : A questionnaire-based evaluation of intensive care medicine in Austria.Wiener klinische Wochenschrift · 2022Article
- Readmission into intensive care unit in patients with aneurysmal subarachnoid hemorrhage.Journal of cerebrovascular and endovascular neurosurgery · 2021Article
Corrections and comments
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Authors and funding
5 authors.
Funding
Abstract
objectivesTo examine whether and how step-down unit admission after ICU discharge affects patient outcomes.
designRetrospective study using an instrumental variable approach to remove potential biases from unobserved differences in illness severity for patients admitted to the step-down unit after ICU discharge.
settingTen hospitals in an integrated healthcare delivery system in Northern California. PATIENTS: Eleven-thousand fifty-eight episodes involving patients who were admitted via emergency departments to a medical service from July 2010 to June 2011, were admitted to the ICU at least once during their hospitalization, and were discharged from the ICU to the step-down unit or the ward.
interventionsNone. MEASUREMENTS AND MAIN
resultsUsing congestion in the step-down unit as an instrumental variable, we quantified the impact of step-down unit care in terms of clinical and operational outcomes. On average, for ICU patients with lower illness severity, we found that availability of step-down unit care was associated with an absolute decrease in the likelihood of hospital readmission within 30 days of 3.9% (95% CI, 3.6-4.1%). We did not find statistically significant effects on other outcomes. For ICU patients with higher illness severity, we found that availability of step-down unit care was associated with an absolute decrease in in-hospital mortality of 2.5% (95% CI, 2.3-2.6%), a decrease in remaining hospital length-of-stay of 1.1 days (95% CI, 1.0-1.2 d), and a decrease in the likelihood of ICU readmission within 5 days of 3.6% (95% CI, 3.3-3.8%).
conclusionsThis study shows that there exists a subset of patients discharged from the ICU who may benefit from care in an step-down unit relative to that in the ward. We found that step-down unit care was associated with statistically significant improvements in patient outcomes especially for high-risk patients. Our results suggest that step-down units can provide effective transitional care for ICU patients.
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