Frequency, Risk Factors, and Outcomes of Early Unplanned Readmissions to PICUs*

Edwards, Jeffrey D.; Lucas, Adam R.; Stone, Patricia W.; Boscardin, W. John; Dudley, R. Adams

doi:10.1097/ccm.0b013e31829eb970

Cited by 62 publications

(76 citation statements)

References 29 publications

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“…A recent survey suggested that pediatric hospitals vary widely in their use of IMCUs, but that having an IMCU provides an alternative location to the PICU to care for patients needing intense monitoring and nursing care[16]. PICU patients discharged to IMCUs have tended to be “long-stay” patients[17] and had greater odds of early unplanned PICU readmission[18]. Adult studies of the impact of IMCUs on ICU metrics have provided mixed results regarding ICU and hospital LOS[19,20], illness severity in the ICU[5,7,8], and non-emergency ICU admissions[20].…”

Section: Discussionmentioning

confidence: 99%

Pediatric intermediate care and pediatric intensive care units: PICU metrics and an analysis of patients that use both

Geneslaw

Jia

Lucas

et al. 2017

Journal of Critical Care

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Purpose To examine how intermediate care units (IMCUs) are used in relation to pediatric intensive care units (PICUs), characterize PICU patients that utilize IMCUs, and estimate the impact of IMCUs on PICU metrics. Materials & Methods Retrospective study of PICU patients discharged from 108 hospitals from 2009–2011. Patients admitted from or discharged to IMCUs were characterized. We explored the relationships between having an IMCU and several PICU metrics: physical length-of-stay (LOS), medical LOS, discharge wait time, admission severity of illness, unplanned PICU admissions from wards, and early PICU readmissions. Results Thirty-three percent of sites had an IMCU. After adjusting for known confounders, there was no association between having an IMCU and PICU LOS, mean severity of illness of PICU patients admitted from general wards, or proportion of PICU readmissions or unplanned ward admissions. At sites with an IMCU, patients waited 3.1 hours longer for transfer from the PICU once medically cleared (p<0.001). Conclusions There was no association between having an IMCU and most measures of PICU efficiency. At hospitals with an IMCU, patients spent more time in the PICU once they were cleared for discharge. Other ways that IMCUs might affect PICU efficiency or particular patient populations should be investigated.

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Section: Discussionmentioning

confidence: 99%

Pediatric intermediate care and pediatric intensive care units: PICU metrics and an analysis of patients that use both

Geneslaw

Jia

Lucas

et al. 2017

Journal of Critical Care

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“…Unplanned readmissions are a focus of healthcare quality measurement, as they may be preventable (3) and are associated with worse outcomes (4–5) and higher costs (6–7). Furthermore, repeated critical illness and hospitalization negatively impact patients and families (8–10).…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, repeated critical illness and hospitalization negatively impact patients and families (8–10). Except for a few studies focused on early readmissions (4) and readmissions during the same hospitalization (11–13), it is not known how often unplanned PICU readmissions occur and who are at most risk.…”

Section: Introductionmentioning

confidence: 99%

Repeated Critical Illness and Unplanned Readmissions Within 1 Year to PICUs*

Edwards

Lucas

Boscardin

et al. 2017

Critical Care Medicine

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Objectives To determine the incidence of unplanned readmissions to pediatric intensive care units (PICUs) within one year and examine risk factors associated with repeated readmission. Design, Settings, & Patients Retrospective cohort study of 93,379 patients discharged between 2009 and 2010 from 76 North American PICUs. Measurements Outcomes of index admissions and unplanned readmissions were compared. Timing of readmissions and variation of proportion of readmissions across sites were examined. Cumulative incidence curves for readmission were constructed. Time-to-event analyses were performed to examine factors associated with readmission within one year and to estimate their hazard ratios (HR). Main Results Eleven percent (10,233) of patients had 15,625 unplanned readmissions within one year to the same PICU; 3.4% had two or more readmissions. Readmissions had significantly higher PICU mortality and longer PICU length of stay, compared to index admissions (4.0% versus 2.5%, and 2.5 versus 1.6 days, all P<0.001). Median time to readmission was 30 days for all readmissions; 3.5 days for readmissions during the same hospitalization; and 66 days for different hospitalizations. Time-to-event analyses showed that having more complex chronic conditions (CCCs) was associated with earlier readmission—adjusted HR 2.9 for one CCC; HR 4.8 for two CCC; HR 9.6 for three or more CCC, all P<0.001 compared no CCC). Most specific CCC conferred a greater risk of readmission, and some had considerably higher risk than others. Conclusions Unplanned readmissions occurred in a sizable minority of PICU patients. Patients with CCCs and particular conditions were at much higher risk for readmission.

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“…A patient's readiness for PICU discharge is determined by a number of different factors, most importantly clinical evaluation by experienced PICU physicians and nurses. Despite best efforts, the incidence of code blue events or urgent need for PICU readmission within 48 hours of PICU discharge remains unacceptably high, with a national average of 2-8% [3][4][5]. Since unplanned PICU readmission has been associated with increased length of PICU stay and higher mortality compared to non-readmitted patients (5,6), a tool to identify this at risk population would be of great clinical utility.…”

Section: Introductionmentioning

confidence: 99%