Intensive care unit readmissions in U.S. hospitals

Kramer, Andrew A.; Higgins, Thomas L.; Zimmerman, Jack E.

doi:10.1097/ccm.0b013e31822d751e

Cited by 157 publications

(91 citation statements)

References 15 publications

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“…Second, we assessed readmissions to the ICU within 72 hours. We chose 72 hours as the cutoff in base analyses because it represents the median interval between ICU discharge and readmission for U.S. patients (16, 22). Third, we calculated in-hospital mortality rates for all patients from the time of initial ICU discharge through hospital discharge, including patients who died during an ICU readmission.…”

Section: Methodsmentioning

confidence: 99%

Outcomes Among Patients Discharged From Busy Intensive Care Units

Wagner¹,

Gabler²,

Ratcliffe³

et al. 2013

Ann Intern Med

124

116

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Background Strains on the capacities of intensive care units (ICUs) may influence the quality of ICU-to-floor transitions. Objective To determine how 3 metrics of ICU capacity strain (ICU census, new admissions, and average acuity) measured on days of patient discharges influence ICU length of stay (LOS) and post–ICU discharge outcomes. Design Retrospective cohort study from 2001 to 2008. Setting 155 ICUs in the United States. Patients 200 730 adults discharged from ICUs to hospital floors. Measurements Associations between ICU capacity strain metrics and discharged patient ICU LOS, 72-hour ICU readmissions, subsequent in-hospital death, post–ICU discharge LOS, and hospital discharge destination. Results Increases in the 3 strain variables on the days of ICU discharge were associated with shorter preceding ICU LOS (all P < 0.001) and increased odds of ICU readmissions (all P< 0.050). Going from the 5th to 95th percentiles of strain was associated with a 6.3-hour reduction in ICU LOS (95% CI, 5.3 to 7.3 hours) and a 1.0% increase in the odds of ICU readmission (CI, 0.6% to 1.5%). No strain variable was associated with increased odds of subsequent death, reduced odds of being discharged home from the hospital, or longer total hospital LOS. Limitation Long-term outcomes could not be measured. Conclusion When ICUs are strained, triage decisions seem to be affected such that patients are discharged from the ICU more quickly and, perhaps consequentially, have slightly greater odds of being readmitted to the ICU. However, short-term patient outcomes are unaffected. These results suggest that bed availability pressures may encourage physicians to discharge patients from the ICU more efficiently and that ICU readmissions are unlikely to be causally related to patient outcomes. Primary Funding Source Agency for Healthcare Research and Quality; National Heart, Lung, and Blood Institute; and Society of Critical Care Medicine.

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Section: Methodsmentioning

confidence: 99%

Outcomes Among Patients Discharged From Busy Intensive Care Units

Wagner¹,

Gabler²,

Ratcliffe³

et al. 2013

Ann Intern Med

124

116

View full text Add to dashboard Cite

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“…Among adults, multi-institutional studies have found ICU readmission rates of 2–6% (8, 9), depending on the timeframe considered, and that readmissions are associated with greater risk of in-hospital mortality (10, 11). In pediatrics, however, there have only been a few single-institutional studies (12–16).…”

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confidence: 99%

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

Edwards

Lucas

Stone

et al. 2013

Critical Care Medicine

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Objectives To determine the rate of unplanned PICU readmissions, examine the characteristics of index admissions associated with readmission, and compare outcomes of readmissions versus index admissions. Design Retrospective cohort analysis. Setting Ninety North American PICUs that participated in the Virtual Pediatric Intensive Care Unit Systems. Patients One hundred five thousand four hundred thirty-seven admissions between July 2009 and March 2011. Interventions None. Measurements and Main Results Unplanned PICU readmission within 48 hours of index discharge was the primary outcome. Summary statistics, bivariate analyses, and mixed-effects logistic regression model with random effects for each hospital were performed. There were 1,161 readmissions (1.2%). The readmission rate varied among PICUs (0–3.3%), and acute respiratory (56%), infectious (35%), neurological (28%), and cardiovascular (20%) diagnoses were often present on readmission. Readmission risk increased in patients with two or more complex chronic conditions (adjusted odds ratio, 1.72; p < 0.001), unscheduled index admission (adjusted odds ratio, 1.37; p < 0.001), and transfer to an intermediate unit (adjusted odds ratio, 1.29; p = 0.004, compared with ward). Trauma patients had a decreased risk of readmission (adjusted odds ratio, 0.67; p = 0.003). Gender, race, insurance, age more than 6 months, perioperative status, and nighttime transfer were not associated with readmission. Compared with index admissions, readmissions had longer median PICU length of stay (3.1 vs 1.7 d, p < 0.001) and higher mortality (4% vs 2.5%, p = 0.002). Conclusions Unplanned PICU readmissions were relatively uncommon, but were associated with worse outcomes. Several patient and admission characteristics were associated with readmission. These data help identify high-risk patient groups and inform risk-adjustment for standardized readmission rates.

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“…Quando a readmissão do paciente ocorre na UTI, novas exposições a procedimentos invasivos ocorrem, por isso, os mesmos são considerados mais graves, apresentam um tempo de internação 2,5 vezes maior, apresentam mais comorbidades crônicas e uma probabilidade de óbito quatro vezes maior comparativamente aos pacientes não readmitidos (18)(19)(20) . Foi constatada (Tabela 5) uma elevada taxa de mortalidade de 48% (do total de 44) após a readmissão de pacientes na UTI, na literatura essa taxa variou entre 27% e 69% (20)(21) .…”

Section: Discussionunclassified

Perfil Epidemiológico E Seguimento Após Alta De Pacientes Internados Em Unidade De Terapia Intensiva

Albuquerque

Silva

Souza³

2017

Cogitare Enferm.

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RESUMO: Descrever o perfil epidemiológico e o seguimento após alta de pacientes internados em uma unidade de terapia intensiva. Pesquisa descritiva, seccional e de abordagem quantitativa, por meio de análise documental dos prontuários eletrônicos de pacientes adultos, internados na unidade de terapia intensiva em um hospital de atenção terciária na cidade do Rio de Janeiro, no período de novembro de 2014 a novembro de 2015. Na amostra (n=573) 73% apresentaram idade igual ou acima de 60 anos, que foi associada a maior risco de morte. A média do tempo de internação na unidade de terapia intensiva foi de 10,7 dias, a taxa de óbito na unidade de terapia intensiva foi de 26% (n= 148), sendo que 56% (n=112) foram a óbito por choque séptico. Foram readmitidos na unidade de terapia intensiva 10% (n= 44) dos pacientes que apresentaram maior risco relativo para óbito (p=0,001). As variáveis sexo feminino, idade acima de 60 anos, internação na unidade de terapia intensiva acima de 30 dias e readmissão na unidade são fatores de risco para óbito. DESCRITORES: Unidades de terapia intensiva; Readmissão do paciente; Mortalidade hospitalar; Choque séptico. PERFIL EPIDEMIOLÓGICO E SEGUIMENTO APÓS ALTA DE PACIENTES INTERNADOS EM UNIDADE DE TERAPIA INTENSIVA EPIDEMIOLOGICAL PROFILE AND MONITORING AFTER DISCHARGE OF PATIENTS HOSPITALIZED AT AN INTENSIVE CARE UNITABSTRACT: To describe the epidemiological profile and monitoring after discharge of patients hospitalized at an intensive care unit. Descriptive and cross-sectional research with a quantitative approach, using documentary analysis of adult patients' electronic histories, who were hospitalized at a tertiary care service in the city of Rio de Janeiro between November 2014 and November 2015.In the sample (n=573), 73% were 60 years of age or older, which was associated with a higher risk of death. The mean length of hospitalization at the intensive care unit was 10.7 days, the death rate at the intensive care unit was 26% (n= 148) and 56% (n=112) died of septic shock. Ten percent (n= 44) of patients with relative death risk (p=0.001) were readmitted to the intensive care unit. The variables female sex, age over 60 years, hospitalized at the intensive care unit for more than 30 days and readmission to the unit are risk factors for death. Investigación descriptiva, seccional y de aproximación cuantitativa, mediante análisis documental de los archivos electrónicos de pacientes adultos, internados en la unidad de terapia intensiva en un hospital de atención terciaria en la ciudad de Rio de Janeiro, entre noviembre del 2014 y noviembre del 2015. En la muestra (n=573), 73% tuvo edad igual o superior a 60 años, que fue asociada a mayor riesgo de muerte. El promedio del tiempo de hospitalización en la unidad de terapia intensiva fue 10.7 días, la tasa de óbito en la unidad de cuidados intensivos fue del 26% (n= 148), siendo que 56% (n=112) fallecieron por choque séptico. Fue readmitido en la unidad de terapia intensiva 10% (n= 44) de los pacientes que presentaron mayor riesgo relativo p...

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Intensive care unit readmissions in U.S. hospitals

Cited by 157 publications

References 15 publications

Outcomes Among Patients Discharged From Busy Intensive Care Units

Outcomes Among Patients Discharged From Busy Intensive Care Units

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

Perfil Epidemiológico E Seguimento Após Alta De Pacientes Internados Em Unidade De Terapia Intensiva

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