Risk of factors for readmission in the intensive care unit

Background

Readmission rates have been used as a measure of the results of the quality of care. It is proposed that a significant number of readmissions are potentially avoidable. The only legitimate basis for using precocious readmission as a quality indicator is that it demonstrates one relationship between readmission and the care process during the previous hospital stay. The interest in readmission is driven by the hypothesis that an improvement of care can result in a reduction of the readmissions to and in the costs of the intensive care unit (ICU).

Objective

To identify risk factors for patient readmission for urinary tract infection.

Materials and methods

A cohort study, based on data of patients from the ICU. The internments of 1 January 1999–31 December 2000 for UTI were analyzed. We established two groups: the first group was composed of patients that just presented one admission, and the second group was composed of patients that presented two admissions to the ICU (they were analyzed for the first internment).

Results

In the study period 3034 patients were interned for UTI. In this population, the readmission rate for UTI was 10.7% and the rate of medium occupation was 86.76 ± 4.16%. The readmitted patients presented a medium age of 67.5 years (15.5 years), and for those patients with just a first admission the medium age was 63.2 years (17.2 years) (P < 0.0001); although age was divided into classes it also presented a significant difference. With relationship to sex there were 172 (60.6%) in the group with more than one admission and 1646 (61.9%) in the group with just one admission, without a significant difference. The indexes Acute Physiology and Chronic Health Evaluation II prognostics and Severe Acute Physiology Score II were, on average, for patients with one admission 12.0 (6.3) and 27.7 (11.9), respectively, and for readmitted patients 18.7 (6.4) and 33.1 (12.9), respectively; both with a significant difference. The hospital lengths of stay were 12.8 days (14.9 days) and 39.2 days (41.1 days), in the group with one admission and in the group that presented readmission, respectively; a fact also repeated in the ICU lengths of stay, both with a significant difference. In the multivariate analysis, the presence of creatinine A > 2.0 and systolic pressure < 90 mmHg, in the moment of internment, presented a significant difference.

Conclusion

The patients' precocious identification with risk factors and the care at the moment of discharge for UTI can be decisive to reduce the readmission rates.