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

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

doi:10.1097/ccm.0000000000002439

Cited by 34 publications

(46 citation statements)

References 38 publications

(39 reference statements)

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“…Complex chronic conditions (CCCs) are associated with prolonged length of stay in PICU patients, unplanned readmissions and death [4, 5]. A CCC is defined as ‘ any medical condition that can be reasonably expected to last at least 12 months (unless death intervenes) and to involve either several different organ systems or 1 organ system severely enough to require specialty pediatric care and probably some period of hospitalization in a tertiary care center ’ [6].…”

Section: Introductionmentioning

confidence: 99%

Retrospective cohort study on factors associated with mortality in high-risk pediatric critical care patients in the Netherlands

Verlaat¹,

Wubben

Visser

et al. 2019

BMC Pediatr

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Background High-risk patients in the pediatric intensive care unit (PICU) contribute substantially to PICU-mortality. Complex chronic conditions (CCCs) are associated with death. However, it is unknown whether CCCs also increase mortality in the high-risk PICU-patient. The objective of this study is to determine if CCCs or other factors are associated with mortality in this group. Methods Retrospective cohort study from a national PICU-database (2006–2012, n = 30,778). High-risk PICU-patients, defined as patients < 18 years with a predicted mortality risk > 30% according to either the recalibrated Pediatric Risk of Mortality-II (PRISM) or the Paediatric Index of Mortality 2 (PIM2), were included. Patients with a cardiac arrest before PICU-admission were excluded. Results In total, 492 high-risk PICU patients with mean predicted risk of 24.8% (SD 22.8%) according to recalibrated PIM2 and 40.0% (SD 23.8%) according to recalibrated PRISM were included of which 39.6% died. No association was found between CCCs and non-survival (odds ratio 0.99; 95% CI 0.62–1.59). Higher Glasgow coma scale at PICU admission was associated with lower mortality (odds ratio 0.91; 95% CI 0.87–0.96). Conclusions Complex chronic conditions are not associated with mortality in high-risk PICU patients. Electronic supplementary material The online version of this article (10.1186/s12887-019-1646-9) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

Retrospective cohort study on factors associated with mortality in high-risk pediatric critical care patients in the Netherlands

Verlaat¹,

Wubben

Visser

et al. 2019

BMC Pediatr

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“…Current literature is generally limited to PICU readmissions within the same hospitalization (“bounce-back” patient) or 30-day all-cause hospital readmissions. There are only limited data examining readmissions to the PICU after hospital discharge beyond the 30-day window ( 4 – 6 ). In Brazil, 9.8% of patients were readmitted to the PICU within 1 year after index admission, accounting for 33.0% of PICU days ( 5 ).…”

mentioning

confidence: 99%

“…The median interval between primary discharge and readmission was 73 days, which suggests that the 30-day readmission metric may underestimate the burden placed on PICU resources as a result of any subsequent PICU readmission. In addition, a multiinstitutional study of North American PICUs demonstrated that 11.0% of discharged patients were readmitted to the PICU within 12 months, accounting for one-fifth of all PICU patient days ( 4 ). In Sweden, compared with children with a single PICU admission, those with repeated PICU admissions had a significant decrease in survival over time ( 6 ).…”

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confidence: 99%

Resources and Costs Associated With Repeated Admissions to PICUs

Kane

Hall

Cecil

et al. 2021

Critical Care Explorations

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Objective: To determine the costs and hospital resource use from all PICU patients readmitted with a PICU stay within 12 months of hospital index discharge. Design: Cross-sectional, retrospective cohort study using Pediatric Health Information System. Setting: Fifty-two tertiary children’s hospitals. Subjects: Pediatric patients under 18 years old admitted to the PICU from January 1, 2016, to December 31, 2017. Interventions: None. Measurements and Main Results: Patient characteristics and costs of care were compared between those with readmission requiring PICU care and those with only a single PICU admission per annum. In this 2-year cohort, there were 239,157 index PICU patients of which 36,970 (15.5%) were readmitted and required PICU care during the 12 months following index admission. The total hospital cost for all index admissions and readmissions was $17.3 billion, of which 21.5% ($3.71 billion) were incurred during a readmission stay involving care in the PICU; of the 3,459,079 hospital days, 20.3% (702,200) were readmission days including those where PICU care was required. Of the readmitted patients, 11,703 (30.0%) received only PICU care, accounting for $662 million in costs and 110,215 PICU days. Although 43.6% of all costs were associated with patients who required readmission, these patients only accounted for 15.5% of the index patients and 28% of index hospitalization expenditures. More patients in the readmitted group had chronic complex conditions at index discharge compared with those not readmitted (83.9% vs 54.9%; p < 0.001). Compared with those discharged directly to home without home healthcare, patients discharged to a skilled nursing facility had 18% lower odds of readmission (odds ratio 0.82 [95% CI, 0.75–0.89]; p < 0.001) and those discharged home with home healthcare had 43% higher odds of readmission (odds ratio, 1.43 [95% CI, 1.36–1.51]; p < 0.001). Conclusions: Repeated admissions with PICU care resulted in significant direct medical costs and resource use for U.S. children’s hospitals.

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“…1 In the United States, most of such patients are hospitalized in academic medical centers where they can access multiple subspecialists along with facilities and therapies integral to complex care. 2,3 While the actual number of such patients at any given center may be relatively small, these patients account for a disproportionate number of ICU bed days. 2,4 After their initial acute stabilization, many days and weeks of their ICU stays involve chronic management of conditions that are stabilized with mechanical ventilation, continuous medication infusions, and other medical equipment or therapies not provided outside of the ICU.…”

Section: Introductionmentioning

confidence: 99%

Slow and Steady: A Systematic Review of ICU Care Models Relevant to Pediatric Chronic Critical Illness

Troch

Schwartz

Boss

2020

J Pediatr Intensive Care

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There is a growing population of children with prolonged intensive care unit (ICU) hospitalization. These children with chronic critical illness (CCI) have a high health care utilization. Emerging data suggest a mismatch between the ICU acute care models and the daily care needs of these patients. Clinicians and parents report that the frequent treatment alterations typical for ICU care may be interrupting and jeopardizing the slow recoveries typical for children with CCI. These frequent treatment titrations could therefore be prolonging ICU stays even further. The aim of this study is to evaluate and summarize existing literature regarding pace and consistency of ICU care for patients with CCI. We performed a systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (of September 2018). PubMed (biomedical and life sciences literature), Excerpta Medica database (EMBASE), and The Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched for English-language studies with data about CCI, care models, and pacing of clinical management. Four unique papers were identified. Our most important finding was that quality data on chronic ICU management, particularly for children, is sparse. All papers in this review confirmed the unique needs of chronic patients, particularly related to respiratory management, which is a common driver of ICU length of stay. Taken together, the papers support the hypothesis that protocols to reduce interdisciplinary management variability and to allow for slower management pacing should be studied for their impact on patient and health system outcomes. Optimizing value in ICU care requires mapping of resources to patient needs, particularly for patients with the most intense resource utilization. For children with CCI, parents and clinicians report that rapid treatment changes undermine recovery and prolong ICU stays. This review highlights the lack of quality pediatric research in this area and supports further investigation of a “slow and steady” approach to ICU management for children with CCI.

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

Cited by 34 publications

References 38 publications

Retrospective cohort study on factors associated with mortality in high-risk pediatric critical care patients in the Netherlands

Retrospective cohort study on factors associated with mortality in high-risk pediatric critical care patients in the Netherlands

Resources and Costs Associated With Repeated Admissions to PICUs

Slow and Steady: A Systematic Review of ICU Care Models Relevant to Pediatric Chronic Critical Illness

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