PURPOSE: 10% of ICU patients are readmitted after transfer to the medical floor. Readmissions are associated with higher mortality, longer hospital stay and complications. Identifying patients at risk is an important step to decrease morbid-mortality. Factors associated with readmissions and outcomes following hospital discharge in ICU patients have not been investigated.Our goal is to characterize ICU patients readmitted within seven days from hospital discharge, identify risk factors, and determine the incidence of readmissions, mortality, and length of stay (LOS).
METHODS: We performed a retrospective examination using the electronic medical records of ICU patients admitted between July 2005 and January 2010. Eligible subjects were 18 years or older who were readmitted within seven days of hospital dischargeDemographic characteristics, co morbidity index, Acute Physiology Score, diagnosis, mechanical ventilation requirement, use of vasopressors, LOS in the hospital and MICU, and mortality rate were recorded.
RESULTS: 4954 patients were discharged from the ICU between 2005 and 2010. In this cohort, 330 (6.6%) were readmitted to the hospital within 7 days. Over half of subjects (58%) had been discharged home. The total hospital LOS was 10.3 days and MICU LOS 4.12 days. Readmissions within seven days were associated with a total hospital mortality rate of 9%. The need for mechanical ventilation was 68% during the ICU admission and 46% during readmission.
CONCLUSION: ICU patients requiring readmission within seven days have a high mortality rates and need for mechanical ventilation. The rate is similar to patients who are readmitted to the ICU from the medical floor. Sepsis is a common cause of both ICU admission and readmission.
CLINICAL IMPLICATIONS: Discharged ICU patients requiring quick readmission are very sick. The high rate of sepsis and mechanical ventilation requirement may reflects the lack of good screening tools to identify at risk patients who may benefit from discharge care planning and shorter length of follow up. Screening tools should be generated to identify this at risk population.
DISCLOSURE: Diana Guerra, No Financial Disclosure Information; No Product/Research Disclosure Information