PURPOSE: Readmissions to medical intensive care units (MICU) are seen in 4-14 percent of MICU discharges and carries higher mortality and poor outcomes. Studies looking into the predictors of MICU readmissions have not been consistent or reproducible. There are no studies comparing the outcomes for patients readmitted for the same or different admitting diagnosis. The goals of the study were to evaluate the incidence, causes and outcome of MICU readmissions.
METHODS: Retrospectively review of all patients readmitted to MICU between January 2008 and December 2009. Primary outcome were mortality, MICU length of stay (LOS) and Ventilator days (VD). Secondary analysis was done comparing readmissions based on re-admitting diagnosis.
RESULTS: There were 3724 admissions in the study period, 229 readmissions in 163 patients. Significant findings in readmitted patients were: age (56.3±18.3 vs 62±15.6; P=<0.0001), APACHE IV (67.5±30.7 vs 88.5±31.2; P=<0.0001) and need for mechanical ventilation (MV) (963 (25.8%) vs 108(66.2%);P=<0.0001) . Re-admissions had a higher mortality (92(56%) vs 348(9.3%);P=<0.0001), higher MICU-LOS(6.3±6 vs 3.7±:P=<0.0001) and higher VD’s (7.7±7.8 vs 6±5.5;P=0.017) Of the 163 re-admissions, 55 were re-admitted with the same illness compared to 108 with different illness. There was no difference for age, gender, APACHE IV scores between the groups; mortality, VD’s and MICU LOS was similar as well. Of the 163 readmitted patients, 147 patients were from community and 17 from nursing homes (NH). Subgroup analysis of re-admitted community patients showed a mortality of 55% and discharge to a NH in 28.5%.
CONCLUSIONS: Readmitted patients have a higher mortality and VD’s and longer MICU-LOS. There is no difference in outcomes in patients readmitted with the same illness compared to different illness.
CLINICAL IMPLICATIONS: Outcome for patients readmitted to our inner city MICU is poor compared to non-readmissions irrespective of readmission diagnosis. MICU discharges should be critically reviewed, with especial focus on community patients, as only 13.6% of those patient readmitted to the MICU are discharged home.
DISCLOSURE: The following authors have nothing to disclose: Misbahuddin Khaja, Gilda Diaz-Fuentes, Venketraman Sahasranaman, Sindhaghatta Venkatram
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