Unplanned pediatric intensive care unit readmissions: A single-center experience

Bernard, Aline M.; Czaja, Angela S.

doi:10.1016/j.jcrc.2013.02.008

Cited by 29 publications

(35 citation statements)

References 32 publications

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“…Two such studies reported that 7–8% of patients had planned or unplanned readmissions within any timeframe during the hospitalization (12, 13). Bernard and Czaja (16) found that 1.8% of their patients had unplanned readmissions within 48 hours; Bastero-Miñón et al (15) found that 2.4% of pediatric cardiac ICU patients had unplanned readmissions within 72 hours.…”

Section: Discussionmentioning

confidence: 99%

“…This timeframe has been suggested by the Society of Critical Care Medicine (4). However, no consensus exists in the literature about what constitutes “early” ICU readmission; both 48 (9, 14, 16, 18) and 72 (15, 19–21) hours have been used. VPS unique patient identifiers permitted detection of readmission to the same PICU.…”

Section: Methodsmentioning

confidence: 99%

“…In pediatrics, however, there have only been a few single-institutional studies (12–16). Thus, little generalizable information about the frequency, risk factors, or outcomes of unplanned readmissions is available.…”

mentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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

Edwards

Lucas

Stone

et al. 2013

Critical Care Medicine

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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%

Pediatric Early Warning Score and unplanned readmission to the pediatric intensive care unit

Mandell

Bynum

Marshall

et al. 2015

Journal of Critical Care

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“…11 Although unplanned readmissions are infrequent, the outcomes are worse than those of planned readmissions. 12,13 In a study by Jäderling et al, 9 adult patients admitted to the ICU from general medical units after RRT initiation had higher mortality than did patients admitted after direct physician contact and admission with no activation of the RRT. In our study, we were unable to compare mortality rate between RRT and non-RRT transfers to the PICU because the data in our RRT database was delinked from patient identifiers such as name and medical record number.…”

Section: Discussionmentioning

confidence: 99%

Rapid Response Team Calls and Unplanned Transfers to the Pediatric Intensive Care Unit in a Pediatric Hospital

Humphreys

Totapally

2016

American Journal of Critical Care

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Background Variability in disposition of children according to the time of rapid response calls is unknown. Objective To evaluate times and disposition of rapid response alerts and outcomes for children transferred from acute care to intensive care. Methods Deidentified data on demographics, time and disposition of the child after activation of a rapid response, time of transfer to intensive care, and patient outcomes were reviewed retrospectively. Data for rapid-response patients on time of activation of the response and unplanned transfers to the intensive care unit were compared with data on other patients admitted to the unit. Results Of 542 rapid responses activated, 321 (59.2%) were called during the daytime. Out of all rapid response activations, 323 children (59.6%) were transferred to intensive care, 164 (30.3%) remained on the general unit, and 19 (3.5%) required resuscitation. More children were transferred to intensive care after rapid response alerts (P = .048) during the daytime (66%) than at night (59%). During the same period, 1313 patients were transferred to intensive care from acute care units. Age, sex, risk of mortality, length of stay, and mortality rate did not differ according to the time of transfer. Mortality among unplanned transfers (3.8%) was significantly higher (P < .001) than among other intensive care patients (1.4%). Conclusion Only 25% of transfers from acute care units to the intensive care unit occurred after activation of a rapid response team. Most rapid responses were called during daytime hours. Mortality was significantly higher among unplanned transfers from acute care than among other intensive care admissions.

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Unplanned pediatric intensive care unit readmissions: A single-center experience

Cited by 29 publications

References 32 publications

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

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

Pediatric Early Warning Score and unplanned readmission to the pediatric intensive care unit

Rapid Response Team Calls and Unplanned Transfers to the Pediatric Intensive Care Unit in a Pediatric Hospital

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