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ICU readmission: good or bad?

Introduction

Patients requiring ICU management risk deterioration following discharge. Readmission to the ICU is used as a marker of performance [1] with some controversy [2]. It is established that higher APACHE II scores and longer length of ICU stay are associated with higher risk of ICU readmission [3]. However, there are no criteria available to identify those patients most likely to benefit from readmission [4].

Methods

Prospective data were collected on all patients admitted to a multidisciplinary adult ICU between 2001 and 2009 and entered into a computerised database. This included length of ICU stay, ICU and hospital outcomes, readmission to ICU and days prior to readmission. Data for all ICU admissions were analysed annually.

Results

There were 5,004 patients admitted during 2001 to 2009; 1,315 (26%) were elective postoperative admissions and 3,689 (74%) emergency admissions. The ICU mortality during this period was 15.8% and mean APACHE II score was 17.7 (1 to 55). There were 299 readmissions (6%). The average time between discharge and readmission was 8.5 days (0 to 89) with a mean length of ICU stay of 5.89 days (0.2 to 48.8). The average hospital mortality rate of readmitted patients was 33% and fell from 69% in 2003 to 24% in 2007. The proportion of readmitted patients increased from 3% (11) in 2001 to 10% (68) in 2007. As the proportion of patients readmitted increased, the hospital mortality rates for all ICU admissions fell 10% from 31% in 2001 to 21% in 2009.

Conclusions

As the number of patients readmitted has increased, hospital mortality of both readmitted patients and total ICU patients have fallen. Those readmitted have had a short length of stay (mean 5.89 days).

References

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    Society of Critical Care Medicine Quality Indicators Committee: Candidate Critical Care Quality Indicators. Anaheim, CA: Society of Critical Care Medicine; 1995.

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  2. 2.

    Cooper GS, et al.: Are readmissions to the intensive care unit a useful measure of hospital performance? Med Care 1999, 37: 399-408.

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    Chan KS, et al.: Readmission to the intensive care unit: an indicator that reflects the potential risks of morbidity and mortality of surgical patients in the intensive care unit. Surg Today 2009, 39: 295-299.

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    Campbell AJ, et al.: Predicting death and readmission after intensive care discharge. Br J Anaesth 2008, 100: 656-662.

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Correspondence to E Potter.

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Potter, E., Vondra, D., Green, S. et al. ICU readmission: good or bad?. Crit Care 15, P461 (2011). https://doi.org/10.1186/cc9881

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Keywords

  • Hospital Mortality
  • Longe Length
  • Emergency Admission
  • Average Hospital
  • Computerise Database