Analysis of Rothman Index Data to Predict Postdischarge Adverse Events in a Medical Intensive Care Unit

Abstract

Patients who have an RI < 50 or a very high-risk warning alert have a higher risk of adverse events postdischarge from the ICU. Rothman Index may be a useful metric for ICU discharge decision-making.

Transition of care at discharge from the Intensive Care Unit: a scoping review

“…Survival after a critical illness is often associated with a long path and a potentially complicated recovery, which affects the quality of life of patients and their caregivers, and can persist for years after hospitalization ( 17 ) . On the other hand, delaying discharge from the ICU also brings unfavorable outcomes, such as inefficient use of hospital resources and delay in the hospitalization of other critical patients ( 8 , 11 ) .…”

“…Some studies suggest the use of scores to define patient readiness for discharge, such as the Stability and Workload Index for Transfer (SWIFT) ( 50 ) scale, which includes in the score the patient’s original unit and length of stay in the ICU, the Glasgow Coma Scale (GCS), the ratio of partial arterial oxygen pressure (PaO2)/inspired fraction of oxygen (IfO2) and arterial pressure of carbon dioxide (ApCO2). Other studies using risk scores to guide the decision to discharge ( 8 , 55 ) include physiological, clinical and laboratory results measures like vital signs, clinical assessment, Braden scale scores, laboratory tests, and heart rate, jointly. Altered vital signs and level of consciousness at the moment of discharge are also suggested as predictors of risk for clinical deterioration in the IU independently ( 10 , 12 ) , or composing a scale ( 56 ) .…”

“…The occurrence of adverse events after discharge from the ICU is related to events with medication, falls and nosocomial infection, clinical deterioration, cardiorespiratory arrest, readmission and death ( 8 - 11 ) . However, studies that assess the occurrence of other outcomes are still scarce; and most focus only on readmission and death rates ( 6 , 12 - 14 ) .…”

“…The adoption of standardized and precise guidelines is important to determine the ideal time for discharge, as well as to predict patients at greatest risk of suffering adverse events after the transfer. However, risk factors and discharge criteria are not clearly defined ( 8 , 10 - 11 , 15 ) . Although guidelines and transition programs are considered effective management tools to reduce length of stay and improve use of resource, few institutions have a policy regarding transition of care or written guidelines for the discharge process from the ICU ( 4 , 15 ) .…”

Calidad del servicio de atención, cumplimiento de protocolos y manejo de normas de bioseguridad en las unidades de cuidados intensivos

“…Es además, una gran preocupación las conocidas infecciones asociadas a la atención en salud (IAAS), estas pueden afligir a los usuarios en cualquier tipo de entorno donde reciben la atención sanitaria (Coello, 2017;González et 2019), ya sean, adquiridas en la institución hospitalaria o las surgidas también después de haber recibido el alta, como plantea la Organización Mundial de la Salud, hasta en ese momento han aparecido complicaciones, tales como: infecciones hospitalarias, caídas, paro cardio-respiratorio, fallecimiento, entre otros (Gotur et al, 2018). En las UCI el inconveniente se subscribe en estar al tanto de los factores que circundan al paciente crítico, en saber programar la atención, cumplir los protocolos y las directrices para otorgarle una mejor calidad de atención (Espinel et al, 2020;Quintana y Tinajero, 2020).…”