Predictors and Outcome of Patients Readmitted to Intensive Care Unit

Abstract

A high ICU readmission rate may indicate inappropriate ICU discharge. Alternatively, it may reflect an oversubscribed ICU, inadequate floor care or resources, or the use of the ICU as a safety net for patients who could be managed on the floor but for whom the ICU is perceived to provide additional benefit, such as a lower nurse-patient ratio. It is unclear whether patient readmission to the ICU is dependent on the decision to discharge, the level of care provided outside the ICU or a combination of these 2 factors. The aim of this study was to predict the outcome of patients readmitted to ICU and to pick up reasons of readmission. Also, the sensitivity and specificity of possible supposed predictors as criteria for discharge from ICU, so that strategies for quality of care and criteria for discharge from ICU might be modified. The present study was conducted in Theodor Bilharz Research Institute's ICU throughout 18 months, after approval of medical ethical committee and informed written consents from patients and/or their relatives were taken. Patients in the study were divided into two groups; group‘R’: included patients who were readmitted to ICU during their hospital stay after being discharged to hospital ward and group ‘N’: non- readmitted patients. A Comparison between the two groups and between the recorded data of the readmitted group during their 1st and 2nd ICU admissions were done. All patients in the study were subjected to routine ICU management including full clinical history taking, detailed clinical examination, and investigations as required (e.g. complete blood count, coagulation profile, renal function tests & liver function tests). The severity of illness was evaluated with the 1st day APACHE III score and daily SOFA scoring during ICU stay starting from the 2nd day. On ICU discharge, the Stability and Workload Index for Transfer (SWIFT) score was recorded. During the study period, of the 180 patients discharged from the ICU alive following their first ICU stay, 42 patients (23.3%) were subjected to unplanned ICU readmission and 6 patients (3.3%) were readmitted within 48 hours after discharge. Early readmissions (within 48 hours) were mainly due to new insults. Post operative complications and sepsis were the most common causes of ICU readmission, then the respiratory, cardiac and metabolic causes. Readmitted patients had higher