PURPOSE: To introduce a discussion of the SWIFT score as part of ICU discharge planning in an attempt to reduce the rate of readmission in patients with a score >15.
METHODS: A print out of the automatically calculated SWIFT score was provided as part of the nursing and attending rounding flow sheets as well as to the charge nurse in adult medical ICUs beginning December 2008. Quality initiative coaches educated physicians and nurses regarding the appropriate use of the SWIFT score as a component of a discharge discussion. The primary outcome measure was whether patients with a SWIFT score >15 had this discussed during discharge planning on morning rounds. Secondary outcomes were impact of SWIFT score discussion on discharge planning and verbal communication with receiving services.
RESULTS: After excluding patients who denied research authorization, were discharged to a comfort/palliative care facility, another hospital or ICU, 1938 patients were included as ICU discharges over a period of 1 year. The SWIFT score at discharge was >15 in 508 patients, of which the score was discussed in 127 (25.0%). Discussion of SWIFT score varied over the study duration, maximum being in second quarter. Discussion led to a change in management (change in discharge service or keep in unit) in 27 (21.3%) and an increase in verbal communication with the receiving services in 23 (18.1%) discharges. The overall impact (change in management or increase in verbal communication with receiving service) of SWIFT score discussion on discharge planning was in 46 (36.2%) discharges and was significantly associated with SWIFT score of >15, p<0.001.
CONCLUSIONS: Discussion of SWIFT score peaked in the second quarter of the 1 year study period. SWIFT discussion had an impact on discharge planning and resulted in increased communication with receiving service.
CLINICAL IMPLICATIONS: Introduction of SWIFT discussion impacts discharge planning and increase communication with receiving service. This could potentially decrease unplanned readmission to ICU.
DISCLOSURE: The following authors have nothing to disclose: Subhash Chandra, Rahul Kashyap, Ramez Smairat, Jyoti Assudani, Vitaly Herasevich, Ognjen Gajic, Brian Pickering
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