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Patient Handover Protocol From Intensive Care Unit, Effect on ICU Readmission Rate, and Predictability of Clinical Variables in ICU Readmitted Patients FREE TO VIEW

John Frattini, MD; Bhavna Desai, RRT
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Saint Luke's Hospital, Saint Louis, MO

Chest. 2013;144(4_MeetingAbstracts):563A. doi:10.1378/chest.1704745
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SESSION TITLE: Outcomes/Quality Control Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: Transition of healthcare from intensive care unit (ICU) to medical ward is a critical handover for physicians, nurses and therapists. Patient decompensation may result in readmission to ICU. ICU readmission will have a negative impact on a patient’s outcome, resulting in longer ICU and hospital length of stay, and higher morbidity and mortality. Patient handover protocols are not currently standardized. We believe improved patient handoff between physicians will enhance patient care, lower ICU readmission rate and foster collegial medical discussion and learning.

METHODS: We prospectively studied a handoff protocol in medically ill patients, between ICU and ward. We utilized written and verbal handoff between ICU and ward residents. We hypothesized that written and face to face verbal handoff between medical residents would lower ICU monthly readmission rate. We used readmission data from the same months during previous year as a comparison group. We studied all patients admitted to an ICU from September 2012 until December 2012. Readmitted patients during this time were initially admitted to ICU, transferred to ward, and then readmitted to same ICU. We excluded all palliative care patients. We also reviewed characteristics in both readmitted patient groups to identify variables which might have predicted readmission to ICU, prior to transfer to ward. Readmitted patient characteristics were evaluated upon presentation to ICU, and at time of discharge from ICU. We reviewed over 50 variables including demographic data, comorbid conditions, vital signs, clinical data, and laboratory data.

RESULTS: We admitted 175 patients to ICU during 91 day period. Ten patients were readmitted. September readmission rate was 7.1% (3/42), October readmission rate was 7.5% (5/67), and November readmission rate was 3.1% (2/65). We found no specific variable which would have predicted a readmission to ICU.

CONCLUSIONS: The average monthly ICU readmission rate was 5.9%. The comparison group ICU monthly readmission rate was 3.6% with a range 0% to 10%. Although no statistically significant result, our protocol improved readmission rate range.

CLINICAL IMPLICATIONS: We need more study to substantially lower ICU readmission rates and predict ICU patient readmissions.

DISCLOSURE: The following authors have nothing to disclose: John Frattini, Bhavna Desai

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