Predicting ICU readmission among surgical ICU patients: Development and validation of a clinical nomogram

Martin, Luke; Kilpatrick, Julie A.; Al-Dulaimi, Ragheed; Mone, Mary C.; Tonna, Joseph E.; Barton, Richard G.; Brooke, Benjamin S.

doi:10.1016/j.surg.2018.06.053

Cited by 17 publications

(31 citation statements)

References 25 publications

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“…There is a problem associated with patients being readmitted to the intensive care unit (ICU) following transfer from the ICU to the medical floor. Hospitals rely on quality metrics to address many aspects of patient care; one of those metrics is the unplanned ICU readmission within 72 hours of transfer [1]. ICU readmission or bounce backs are associated with worse outcomes for the patient and increased resource utilization [2].…”

Section: Introductionmentioning

confidence: 99%

“…Among the most common reasons for readmissions were pneumonia and respiratory failure [18,19]. Although primary reasons for readmission to the ICU have been established within the medical critical care population, the reasons have not clearly been delineated for the surgical population [1]. This problem has been identified at the national level [1,5] and at the local level as well.…”

Section: Introductionmentioning

confidence: 99%

“…Although primary reasons for readmission to the ICU have been established within the medical critical care population, the reasons have not clearly been delineated for the surgical population [1]. This problem has been identified at the national level [1,5] and at the local level as well. Surgical trauma ICU readmissions have been noted specifically at a local hospital in the southern Piedmont region of North Carolina.…”

Section: Introductionmentioning

confidence: 99%

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Impact of Intensive Care Unit Readmissions on Patient Outcomes and the Evaluation of the National Early Warning Score to Prevent Readmissions: Literature Review (Preprint)

Mcneill¹,

Khairat²

2019

Preprint

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BACKGROUND Intensive care unit (ICU) readmissions have been shown to increase a patient’s in-hospital mortality and length of stay (LOS). Despite this, no methods have been set in place to prevent readmissions from occurring. OBJECTIVE The aim of this literature review was to evaluate the impact of ICU readmission on patient outcomes and to evaluate the effect of using a risk stratification tool, the National Early Warning Score (NEWS), on ICU readmissions. METHODS A database search was performed on PubMed, Cumulative Index of Nursing and Allied Health Literature, Google Scholar, and ProQuest. In the initial search, 2028 articles were retrieved; after inclusion and exclusion criteria were applied, 12 articles were ultimately used in this literature review. RESULTS This literature review found that patients readmitted to the ICU have an increased mortality rate and LOS at the hospital. The sample sizes in the reviewed studies ranged from 158 to 745,187 patients. Readmissions were most commonly associated with respiratory issues about 18% to 59% of the time. The NEWS has been shown to detect early clinical deterioration in a patient within 24 hours of transfer, with a 95% CI of 0.89 to 0.94 (<i>P</i><.001), a sensitivity of 93.6% , and a specificity of 82.2%. CONCLUSIONS ICU readmissions are associated with worse patient outcomes, including hospital mortality and increased LOS. Without the use of an objective screening tool, the provider has been solely responsible for the decision of patient transfer. Assessment with the NEWS could be helpful in decreasing the frequency of inappropriate transfers and ultimately ICU readmission.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Impact of Intensive Care Unit Readmissions on Patient Outcomes and the Evaluation of the National Early Warning Score to Prevent Readmissions: Literature Review (Preprint)

Mcneill¹,

Khairat²

2019

Preprint

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“…Many variables have been identified as potential risk factors predisposing to ICU bounceback. These include Glasgow Coma Score <9, 4 increasing age, 8,9,13,14,17,19,21,22,24,25,[30][31][32] male gender, 4,12,[18][19][20] and existence of concurrent comorbidities. 4,7,21 Initial ICU length of stay is also a risk factor for ICU bounceback.…”

mentioning

confidence: 99%

“…14 A nomogram is a line chart that depicts scales for variable (risk of readmission) involved in a particular formula in such a way that corresponding values for each variable (respiratory rate, blood urea nitrogen, age, serum glucose, sodium chloride, history of atrial fibrillation, history of renal insufficiency) lie in a straight line intersecting all of the scales. 14,46 Risk factors of bounceback were identified with points assigned to each predictor variable to graphically assess overall risk. Although general details of various strategies introduced to combat ICU readmissions have been described, no conclusive evidence has yet materialized regarding best practices to lower bounceback rates.…”

mentioning

confidence: 99%

A Comprehensive Review of the Outcome for Patients Readmitted to the ICU Following Trauma and Strategies to Decrease Readmission Rates

Morgan

Vernon

Bradburn

et al. 2020

J Intensive Care Med

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In recent years, there has been an emphasis on evaluating the outcomes of patients who have experienced an intensive care unit (ICU) readmission. This may in part be due to the Patient Protection and Affordable Care Act’s Hospital Readmission Reduction Program which imposes financial sanctions on hospitals who have excessive readmission rates, informally known as bounceback rates. The financial cost associated with avoidable bounceback combined with the potentially preventable expenses can result in unnecessary financial strain. Within the hospital readmissions, there is a subset pertaining to unplanned readmission to the ICU. Although there have been studies regarding ICU bounceback, there are limited studies regarding ICU bounceback of trauma patients and even fewer proven strategies. Although many studies have concluded that respiratory complications were the most common factor influencing ICU readmissions, there is inconclusive evidence in terms of a broadly applicable strategy that would facilitate management of these patients. The purpose of this review is to highlight the outcomes of patients readmitted to the ICU and to provide an overview of possible strategies to aid in decreasing ICU readmission rates.

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Intensive care unit readmission and unexpected death after emergency general surgery

Guo¹,

Cui²

2023

Heliyon

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Predicting ICU readmission among surgical ICU patients: Development and validation of a clinical nomogram

Cited by 17 publications

References 25 publications

Impact of Intensive Care Unit Readmissions on Patient Outcomes and the Evaluation of the National Early Warning Score to Prevent Readmissions: Literature Review (Preprint)

Impact of Intensive Care Unit Readmissions on Patient Outcomes and the Evaluation of the National Early Warning Score to Prevent Readmissions: Literature Review (Preprint)

A Comprehensive Review of the Outcome for Patients Readmitted to the ICU Following Trauma and Strategies to Decrease Readmission Rates

Intensive care unit readmission and unexpected death after emergency general surgery

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