Readmission to the ICU within 24 hours of transfer out(bounce backs) is an accepted measure of quality, however the population of patients initially admitted to the ward who subsequently require transfer to the ICU within 24 hours has not been evaluated. We describe our experience with this population of ‘ bounce in ‘ patients to the ICU.
Records of all patients initially admitted to the ward who were subsequently transfered to the ICU within a 24 hour period were evaluated to determine whether ICU admission could have been predicted during the initial workup.
During a 7 month period 37 ‘bounce in’ patients were identified. 15 of those were identified as having had predictable ICU admission by virtue of initial clinical condition or laboratory data. The remaining 22 patients had no data indicative of predictable ICU admission or were transferred to the ICU for reasons unrelated to their presenting diagnosis, such as need for emergent surgery or development of unanticipated dysrrythmia in non-cardiac patients. Of the 15 ‘bounce in’ patients transferred to the ICU predictable respiratory deterioration was the major factor identified. Several other factors predicting ICU transfer included unexplained acidosis, seizure associated with DT's and new onset atrial fibrillation. Followup included education of the admitting services on the prudence of evaluation of these patient populations for ICU admission prior to admission to the general wards.
A significant number of patients require transfer to the ICU within 24 hours of admission to the hospital. This presumably results in increased patient morbidity and length of stay. An evaluation of this patient population has the potential to identify opportunities within an institution for which an educational program for admitting services such as hospitalists and ED physicians could be developed.
Initial admission of patients with predictive data for subsequent deterioration directly to the ICU has the potential to diminish patient morbidity and decrease length of stay for this population of ‘bounce in’ patients to the ICU.
Leo Rotello, No Financial Disclosure Information; No Product/Research Disclosure Information