SESSION TYPE: Improving Processes and Outcomes in Adult Critical Care
PRESENTED ON: Wednesday, October 24, 2012 at 02:45 PM - 04:15 PM
PURPOSE: Hospital 30-day readmissions are indicators of patient safety, quality of care and are associated with high health care cost. However, limited information is available regarding early avoidable readmissions on high health care users such as critically ill mechanically ventilated patients. Our aim was to describe the significance of early readmissions within 30-days after surviving an index admission of critically ill patients who required mechanical ventilation.
METHODS: A retrospective cohort study of critically ill patients requiring invasive mechanical ventilation (MV) at one VA hospital for ≥ 24 hours were identified from January 1, 2007 to December 31, 2008. Index admission was considered the first admission during the two-year period of the patient requiring invasive mechanical ventilation. 30-day readmissions were defined as the first re-admission that occurred within 30 days of hospital discharge. Early readmission occurred within 7 after discharge. The ICD-9 primary diagnosis of the index admission was compared to the primary ICD-9 diagnosis of the first early re-admission episode. Primary outcome was the time to 30-day readmission and the rate of early readmissions. Chi-square and Student s t-test were used to compare categorical and continuous variables, respectively.
RESULTS: We enrolled 286 patients during the two-year period, of which 154 (53.8%) survived the index admission. In survivors, 25 (16.2%) patients required readmission within 30 days of discharge. The mean (SD) time to the first 30-day readmission was 14.4 (9.9) days. Early readmission (less than 7 days) occurred in 8 (5.2%) of hospital survivors, and all of which were readmitted within 3 days from discharge. Length of hospital stay was not associated with early (32.5[21.3] days) vs. 30-day readmission (after 7 days - 32.2 [25.6] days; p=0.97). The most common reason for early readmission was congestive heart failure in 2 subjects, all the other reasons occurred in one subject, respectively. Myocardial infarction and pneumonia were not causes of early readmission.
CONCLUSIONS: Early readmissions after requiring mechanical ventilation are uncommon events in critically ill patients surviving a hospitalization and were not associated with hospital length of stay or specific clinical diagnosis.
CLINICAL IMPLICATIONS: it is unclear if 30-day readmission is a good marker of quality of care, and the small proportion of early readmissions precludes the use of this tool to implement programs for which hospitals are responsible for this outcome.
DISCLOSURE: The following authors have nothing to disclose: Sara Restrepo, Elena Laserna, Antonio Anzueto, Mary Bollinger, Mary Pugh, Luci Leykum, Jacqueline Pugh, Marcos Restrepo
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