A Comprehensive Review of the Outcome for Patients Readmitted to the ICU Following Trauma and Strategies to Decrease Readmission Rates

Abstract

In recent years, there has been an emphasis on evaluating the outcomes of patients who have experienced an intensive care unit (ICU) readmission. This may in part be due to the Patient Protection and Affordable Care Act’s Hospital Readmission Reduction Program which imposes financial sanctions on hospitals who have excessive readmission rates, informally known as bounceback rates. The financial cost associated with avoidable bounceback combined with the potentially preventable expenses can result in unnecessary financial strain. Within the hospital readmissions, there is a subset pertaining to unplanned readmission to the ICU. Although there have been studies regarding ICU bounceback, there are limited studies regarding ICU bounceback of trauma patients and even fewer proven strategies. Although many studies have concluded that respiratory complications were the most common factor influencing ICU readmissions, there is inconclusive evidence in terms of a broadly applicable strategy that would facilitate management of these patients. The purpose of this review is to highlight the outcomes of patients readmitted to the ICU and to provide an overview of possible strategies to aid in decreasing ICU readmission rates.

Targeting zero preventable trauma readmissions

“…[19][20][21] Because more surgical measures are added, 30-day hospital readmissions after emergency surgical procedures are increasingly being scrutinized. 3,22,23 Our study provides additional context for these discussions by naming a pragmatic floor for readmission reduction in trauma care, as well as a potential method for defining pragmatic readmission targets for other specialties. Defining this floor is further relevant because some surgical readmissions are planned 24,25 and, if not classified appropriately, could result in inappropriate penalties.…”

“…The current body of literature evaluating readmissions among trauma patients has focused on association with particular injury patterns, 26 patient characteristics, 3 discharge destination, 23 time to intervention, 27 and inpatient laboratory markers. 28 However, the current study suggests that the readmissions that are most likely to be prevented may not be associated or may even be inversely associated with the severity of the patient's injuries.…”

Predictors of Early and Late Unplanned Intensive Care Unit Readmission: A Retrospective Cohort Study

“…Unplanned ICU readmission has been recognized as one of the major quality indicators of critical care (Kramer et al, 2012). Despite attention paid to this problem for decades, not much progress has been made in identifying associated mechanisms that could guide practical solutions (Morgan et al, 2020). In the results, none of the major predictors of early or late ICU readmission were deemed modifiable or preventable.…”

Factors associated with readmissions to an adult intensive care unit at a university hospital

“…Estudiosos do estado da Pensilvânia, dos Estados Unidos da América, com objetivo de analisar resultados de pacientes readmitidos em Unidades de Terapia Intensiva especializadas para o trauma e inves-tigar estratégias de redução das taxas de reinternação, atestaram que os fatores de risco mais evidentes para reinternação são: idade; complicações respiratórias; gravidade da doença; sexo masculino; sangramentos; doença renal crônica; e dias de ventilação mecânica. Para tanto, inferiu-se que as estratégias para redução das reinternações em Unidade de Terapia Intensiva traumatológicas, possivelmente, redundam no conhecimento singular de cada realidade institucional (14) .…”