Amelioration of Increased Intensive Care Unit Service Readmission Rate after Implementation of Work-Hour Restrictions

Frankel, Heidi L.; Foley, Andrea; Norway, Calvin; Kaplan, Lewis J.

doi:10.1097/01.ta.0000222579.48194.2b

Cited by 23 publications

(5 citation statements)

References 16 publications

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“…Other interventions to help reduce the readmission during the era of the 80-hour workweek have also been successful. 16 In the present study, variables noted on initial ICU admission are different between groups that will subsequently require ICU readmission. Because ICU readmission is associated in both this study as well as others ranging back almost 30 years, 17 with longer length of stay and increased mortality, preventing unplanned readmissions is essential to improving patient care and hospital performance.…”

Section: Discussionmentioning

confidence: 53%

Surgical Intensive Care Unit Admission Variables Predict Subsequent Readmission

Lissauer¹,

Diaz²,

Narayan³

et al. 2013

The American Surgeon™

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Intensive care unit (ICU) readmissions are associated with increased resource use. Defining predictors may improve resource use. Surgical ICU patients requiring readmission will have different characteristics than those who do not. We conducted a retrospective cohort study of a prospectively maintained database. The Acute Physiology and Chronic Health Evaluation (APACHE) IV quality database identified patients admitted January 1 through December 31, 2011. Patients were divided into groups: NREA = patients admitted to the ICU, discharged, and not readmitted versus REA = patients admitted to the ICU, discharged, and readmitted. Comparisons were made at index admission, not readmission. Categorical variables were compared by Fisher's exact testing and continuous variables by t test. Multivariate logistic regression identified independent predictors of readmission. There were 765 admissions. Seventy-seven patients required readmission 94 times (12.8% rate). Sixty-two patients died on initial ICU admission. Admission severity of illness was significantly higher (APACHE III score: 69.54 ± 21.11 vs 54.88 ± 23.48) in the REA group. Discharge acute physiology scores were equal between groups (47.0 ± 39.2 vs 44.2 ± 34.0, P = nonsignificant). In multivariate analysis, REA patients were more likely admitted to emergency surgery (odds ratio, 1.9; 95% confidence interval, 1.01 ± 3.5) more likely to have a history of immunosuppression (2.7, 1.4 ± 5.3) or higher Acute Physiology Score (1.02; 1.0 ± 1.03) than NREA. Patients who require ICU readmission have a different admission profile than those who do not “bounce back.” Understanding these differences may allow for quality improvement projects such as instituting different discharge criteria for different patient populations.

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Section: Discussionmentioning

confidence: 53%

Surgical Intensive Care Unit Admission Variables Predict Subsequent Readmission

Lissauer¹,

Diaz²,

Narayan³

et al. 2013

The American Surgeon™

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“…31 Some articles focused on errors and preventable adverse events associated with the increased number of handoffs attributed to shorter shifts. [32][33][34][35][36] The analysis by Denson and colleagues 37 of a retrospective cohort of adult patients admitted to a university-affiliated hospital across the 2011 revision actually described a trend toward higher all-cause in-hospital mortality; inferences about the implications of more resident handoffs were suggested as an explanation. Babu et al 38 used the NIS to evaluate the effect of the 2003 duty hour restrictions on hospitalized patients who underwent brain tumor and cerebrovascular procedures, and they concluded that the duty hour changes were associated with worse outcomes, namely higher complication rates.…”

Section: Discussionmentioning

confidence: 99%

Associations Between In-Hospital Mortality, Health Care Utilization, and Inpatient Costs With the 2011 Resident Duty Hour Revision

Eid

Ponor

Reed

et al. 2019

Journal of Graduate Medical Education

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Background The Accreditation Council for Graduate Medical Education (ACGME) has mandated revisions to residents' work hours to improve patient safety and enhance resident education and wellness. The impact on clinical outcomes on a national level is poorly understood. Objective We examined data from before and after the ACGME 2011 duty hour revision and looked for differences between teaching and nonteaching US hospitals. Methods A retrospective observational study of patients admitted to hospitals in the 2-year periods before and after the 2011 duty hour revision was conducted, utilizing a nationally representative data set. We compared patient and hospital characteristics using standardized differences. With nonteaching hospitals serving as the control group, we used multiple group interrupted time series segmented regression analysis to test for postrevision level and trend changes in mortality, length of stay (LOS), and costs. Results We examined more than 117 million hospitalizations. At teaching and nonteaching hospitals, trends in mortality and LOS in prerevision and postrevision periods were not significantly different (all P. .05). A significant monthly reduction in cost per hospitalization was noted postrevision at teaching hospitals (P ¼ .019) but not at nonteaching hospitals (P ¼ .62). In the 2 years following the 2011 revision, there was a monthly reduction in cost per hospitalization

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“…Two studies assessed first-year residents, finding improvement in errors under duty-hour limits (12, 13) but a higher rate of errors under longer hours by first-year residents compared to residents more advanced in their training (13). Of 15 single-institution studies that assessed patient safety outcomes in surgical specialties, eight found no significant effect (19)(20)(21)(22)(23)(24)(25)(26), two found small improvements (27,28), and two found worsening of quality and safety, including a significant increase in admissions to surgical intensive care units attributable to provider care (29) and increased complications and morbidity in neurological surgery patients (30). One study of the effect on quality and safety for surgical patients found a reduction in bile duct injuries and complications in the years since the implementation of duty-hour limits, but this was accompanied by a significant increase in the number of surgeries that were converted to open procedures (31).…”

Section: Safety and Quality In Teaching Settingsmentioning

confidence: 99%

“…Patient safety worse 10 studies** 4 studies*** Shetty 34 Volpp(a) 39 Volpp(b) 40 Landrigan(b) 18 Frankel 29 Bailit 32 Poulose 41 Rosen 43 Browne 42 Volpp(a) 39 ***…”

Section: No Changementioning

confidence: 99%

Duty-Hour Limits and Patient Care and Resident Outcomes: Can High-Quality Studies Offer Insight into Complex Relationships?

et al. 2013

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Long hours are an accepted component of resident education, yet data suggest they contribute to fatigue that may compromise patient safety. A systematic review confirms that limiting duty hours increases residents' hours of sleep and improves objective measures of alertness. Most studies of operative experience for surgical residents found no effect, and there is evidence of a limited positive effect on residents' mood. We find a mixed effect on patient safety, although problems with supervision, rather than the limits, may be responsible or contibute; evidence of reduced continuity of care and reduced continuity in residents' clinical education; and evidence that increased workload under the limits has a negative effect on patient and resident outcomes. We highlight specific areas for research and offer recommendations for national policy.

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Amelioration of Increased Intensive Care Unit Service Readmission Rate after Implementation of Work-Hour Restrictions

Abstract: A targeted intervention can reduce the rate of SICU readmission caused by care inadequacies stemming from a resident reallocation strategy.

Cited by 23 publications

References 16 publications

Surgical Intensive Care Unit Admission Variables Predict Subsequent Readmission

Surgical Intensive Care Unit Admission Variables Predict Subsequent Readmission

Associations Between In-Hospital Mortality, Health Care Utilization, and Inpatient Costs With the 2011 Resident Duty Hour Revision

Duty-Hour Limits and Patient Care and Resident Outcomes: Can High-Quality Studies Offer Insight into Complex Relationships?

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