Poster presentation | Open | Published:
Stability and Workload Index for Transfer score predicts unplanned medical ICU patient readmission
Critical Carevolume 10, Article number: P412 (2006)
Unplanned readmission to the medical intensive care unit (MICU) is associated with worse outcome. Unfortunately, the ability to predict which patients are likely to deteriorate after MICU dismissal is limited. We developed and tested a numerical index that measures and quantitates suitability for patient transfer from a critical care unit to a general services care environment (Stability and Workload Index for Transfer [SWIFT] score).
We identified consecutive patients admitted to a tertiary care MICU from May 2004 to May 2005. The primary outcome was unplanned readmission to the MICU or unexpected death on the floor precluding ICU readmission. Utilizing a nursing workload database, an APACHE III database, a computerized medical record and a hospital laboratory database, we extracted information related to patient functional status, severity of illness and the demand for specific nursing interventions. Multivariate logistic regression was used to determine the association between specific risk factors and MICU readmission.
We evaluated 1131 patients during 1242 hospital admissions, 100 of whom were readmitted to the MICU and five died unexpectedly on the floor. Elements of the SWIFT score include: ICU length of stay, ICU admission source, day of discharge Glasgow Coma Scale, PaO2/FIO2 ratio, and the nursing demand for complex respiratory care. The SWIFT score predicted ICU readmission more precisely (ROC curve AUC 0.75) than the day of discharge APACHE III score (AUC 0.62) or day of discharge APACHE III predicted hospital mortality (AUC 0.66).
The initial SWIFT score work has delineated a universally available set of parameters that acceptably correlate with risk of MICU readmission. If validated in an independent sample, the SWIFT score may improve the precision of MICU patient transfer decisions.