A meta-analysis to derive literature-based benchmarks for readmission and hospital mortality after patient discharge from intensive care

Abstract

IntroductionWe sought to derive literature-based summary estimates of readmission to the ICU and hospital mortality among patients discharged alive from the ICU.MethodsWe searched MEDLINE, Embase, CINAHL and the Cochrane Central Register of Controlled Trials from inception to March 2013, as well as the reference lists in the publications of the included studies. We selected cohort studies of ICU discharge prognostic factors that in which readmission to the ICU or hospital mortality among patients discharged alive from the ICU was reported. Two reviewers independently abstracted the number of patients readmitted to the ICU and hospital deaths among patients discharged alive from the ICU. Fixed effects and random effects models were used to estimate the pooled cumulative incidence of ICU readmission and the pooled cumulative incidence of hospital mortality.ResultsThe analysis included 58 studies (n = 2,073,170 patients). The majority of studies followed patients until hospital discharge (n = 46 studies) and reported readmission to the ICU (n = 46 studies) or hospital mortality (n = 49 studies). The cumulative incidence of ICU readmission was 4.0 readmissions (95% confidence interval (CI), 3.9 to 4.0) per 100 patient discharges using fixed effects pooling and 6.3 readmissions (95% CI, 5.6 to 6.9) per 100 patient discharges using random effects pooling. The cumulative incidence of hospital mortality was 3.3 deaths (95% CI, 3.3 to 3.3) per 100 patient discharges using fixed effects pooling and 6.8 deaths (95% CI, 6.1 to 7.6) per 100 patient discharges using random effects pooling. There was significant heterogeneity for the pooled estimates, which was partially explained by patient, institution and study methodological characteristics.ConclusionsUsing current literature estimates, for every 100 patients discharged alive from the ICU, between 4 and 6 patients on average will be readmitted to the ICU and between 3 and 7 patients on average will die prior to hospital discharge. These estimates can inform the selection of benchmarks for quality metrics of transitions of patient care between the ICU and the hospital ward.

Association between time of discharge from ICU and hospital mortality: a systematic review and meta-analysis

“…The two investigators also reviewed the reference lists (Additional file 1: Table S1) of the retrieved studies and relevant reviews to identify additional articles [19, 20]. In instances where further clarification was required, a third investigator (ZW) emailed the corresponding author of the relevant article.…”

Administrator Perspectives on ICU-to-Ward Transfers and Content Contained in Existing Transfer Tools: a Cross-sectional Survey

“…The ICU provides specialized, life-sustaining care to the sickest patients in the hospital. 1,2 These patients have complex medical problems and reduced physiological capacity, 3 leaving them susceptible to medical errors and adverse events [4][5][6][7] during transitions of care.…”

Functional dependence at discharge from the intensive care unit: relevance for rehabilitation nursing

“…For a significant proportion of patients discharged from both the ICU and the hospital, the recovery trajectories are not linear. On average, four to six patients out of 100 discharged from the ICU will be readmitted and between three and seven, on average, will die before hospital discharge (Hosein et al, 2014). For a large number of patients, this transition period means the beginning of a long journey, with the persistent adverse effects of illness or trauma, but also resulting from treatment thereof.…”