Description of PICU Unplanned Readmission*

Kotsakis, Afrothite; Stevens, D.G.; Frndova, Helena; Neal, Richard D; Williamson, G. Gordon; Mohseni-Bod, Hadi; Parshuram, Christopher S.

doi:10.1097/pcc.0000000000000735

Cited by 17 publications

(22 citation statements)

References 18 publications

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“…Some pediatric studies in the literature have investigated the role of vital signs at discharge by using screening tools like pediatric logistic organ dysfunction (PELOD). 18 Acute physiology and chronic health evaluation (APACHE2) 24 and simplified adult physiology score (APS) 3,23 had similarly been utilized as adjustment tools in several adult investigations. Among the many pediatric scoring systems that have been developed worldwide, the PEWS score is one of the simplest and most flexible systems that can be quickly performed and that is not age specific.…”

Section: Discussionmentioning

confidence: 99%

Validity of Pediatric Early Warning Score in Predicting Unplanned Pediatric Intensive Care Unit Readmission

Zoham

Mohammadpour

Yaghmaie

et al. 2021

J Pediatr Intensive Care

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Despite the fact that unscheduled readmission to pediatric intensive care units (PICUs) has significant adverse consequences, there is a need for a predictive tool appropriate for use in the clinical setting. The aim of this study was to assess the ability of the modified Brighton pediatric early warning score (PEWS) to identify children at high risk for early unplanned readmission. In this retrospective cohort study, all patients aged 1 month to 18 years of age discharged from PICUs of two tertiary children's hospitals during the study interval were enrolled. Apart from demographic data, the association between PEWS and early readmission, defined as readmission within 48 hours of discharge, was analyzed by multivariable logistic regression. From 416 patients, 27 patients had early PICU readmission. Patients who experienced readmission were significantly younger than the controls. (≤12 months, 70.4 vs. 39.1%, p = 0.001) Patients who were admitted from the emergency room (66.7 and 33.3% for emergency department (ED) and floor, respectively, p = 0.012) had higher risk of early unplanned readmission. PEWS at discharge was significantly higher in patients who experienced readmission (3.07 vs. 0.8, p < 0.001). A cut-off PEWS of 2, with sensitivity 85.2% and specificity 78.1%, determined the risk of unplanned readmission. Each 1-point increase in the PEWS at discharge significantly increases the risk of readmission (odds ratio [OR] = 3.58, 95% confidence interval [CI]: [2.42–5.31], p < 0.001). PEWS can be utilized as a useful predictive tool regarding predicting unscheduled readmission in PICU. Further large-scale studies are needed to determine its benefits in clinical practice.

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Section: Discussionmentioning

confidence: 99%

Validity of Pediatric Early Warning Score in Predicting Unplanned Pediatric Intensive Care Unit Readmission

Zoham

Mohammadpour

Yaghmaie

et al. 2021

J Pediatr Intensive Care

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“…However, children who may have previously died during their ICU stay are now more likely to survive, potentially resulting in greater morbidity with significant long‐term medical care, including hospital readmission 2 . Readmission after discharge is known to be associated with poorer health outcomes 3,4 …”

Section: What Is Already Known On This Topicmentioning

confidence: 99%

Factors associated with admission of children to an intensive care unit and readmission to hospital within 28 days of discharge: A population‐based study

Bond

Ampt

Festa

et al. 2021

J Paediatrics Child Health

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Hospital readmissions within 28 days are an important performance measurement of quality and safety of health care. The aims of this study were to examine the rates, trends and characteristics of paediatric intensive care unit admissions, and factors associated with readmissions to hospital within 28 days of discharge. Methods: This retrospective, population-based record linkage study included all children ≥28 days and <16 years old admitted to an intensive care unit (ICU) in a New South Wales (NSW) public hospital from 2004 to 2013. Data were sourced from the NSW Admitted Patients Data Collection and the NSW Registry of Births, Deaths and Marriages, Death Registration. Results: We identified 21 200 ICU admissions involving 17 130 children. Admissions increased by 24% over the study period with the greatest increase attributed to respiratory and musculoskeletal conditions. A higher proportion of children were <5 years, male, lived in major cities, were publicly insured and had chronic conditions. The median length of ICU stay was 42 h and overall hospital stay was 7 days. There were 905 deaths, two-thirds during the index admission with the leading causes being injuries, cancer and infections. Twenty-three per cent of ICU admissions were readmitted to hospital within 28 days of discharge. Associated independent factors were younger age, longer index hospital stay and emergency index admission. Children with chronic conditions of cancer and genitourinary disorders were more likely to be readmitted. Conclusions: Identification of complex chronic conditions, consideration of long-term health planning and interventions intended to reduce readmission is warranted in order to reduce the burden to families and the health-care system.

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“…A single site retrospective case control study by Kotsakis et al, found that unplanned readmission was associated with discharge outside their goal discharge time (6:00 am and 11:59 am) on univariable analysis, but this association was no longer significant with multivariable analysis. They still concluded that discharge time of day was one of the few modifiable factors, along with the Pediatric Logistic Organ Dysfunction (PELOD) and Bedside Pediatric Early Warning Signs (BedsidePEWS TM ) scores at time of discharge which may decrease ICU readmissions (29).…”

Section: Nighttime Transfersmentioning

confidence: 99%

“…Between 2.5-5.4% of PICU discharges will have an unplanned PICU readmission (27,29,36,37) with approximately 1/3 to 1/2 of PICU readmissions occurring within the first 48 hours (27,36). Patients readmitted to the ICU are at higher risk of mortality and have longer ICU and hospital LOS ( Table 1).…”

Section: Patient Populationmentioning

confidence: 99%

Going back to the ward—transitioning care back to the ward team

Herbst¹,

Desai²,

Benscoter³

et al. 2018

Transl Pediatr

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Transition of care from the intensive care unit (ICU) to the ward is usually an indication of the patient's improving clinical status, but is also a time when patients are particularly vulnerable. The transition between care teams poses a higher risk of medical error, which can be mitigated by safe and complete patient handoff and medication reconciliation. ICU readmissions are associated with increased mortality as well as ICU and hospital length of stay (LOS); however tools to accurately predict ICU readmission risk are limited. While there are many mechanisms in place to carefully identify patients appropriate for transfer to the ward, the optimal timing of transfer can be affected by ICU strain, limited resources such as ICU beds, and overall hospital capacity and flow leading to suboptimal transfer times or delays in transfer. The patient and family perspectives should also be considered when planning for transfer from the ICU to the ward. During times of transition, families will meet a new care team, experience uncertainty of future care plans, and adjust to a different daily routine which can lead to increased stress and anxiety. Additionally, a subset of patients, such as those with new technology, require additional multidisciplinary support, education and care coordination which can contribute to longer hospital LOS if not addressed proactively early in the hospitalization while the patient remains in the ICU. In this review article, we describe key components of the transfer from ICU to the ward, discuss current strategies to optimize timing of patient transfers, explore strategies to partner with patients and families during the transfer process, highlight patient populations where additional considerations are needed, and identify future areas of exploration which could improve the care transition from the ICU to the ward.

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Description of PICU Unplanned Readmission*

Abstract: The only potentially modifiable factors we found associated with PICU readmission within 48 hours of discharge were discharge time of day and the Pediatric Logistic Organ Dysfunction and Bedside Pediatric Early Warning Scores at the time of PICU discharge.

Cited by 17 publications

References 18 publications

Validity of Pediatric Early Warning Score in Predicting Unplanned Pediatric Intensive Care Unit Readmission

Validity of Pediatric Early Warning Score in Predicting Unplanned Pediatric Intensive Care Unit Readmission

Factors associated with admission of children to an intensive care unit and readmission to hospital within 28 days of discharge: A population‐based study

Going back to the ward—transitioning care back to the ward team

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