The Risk Factors Related to Early Readmission to the Intensive Care Unit

Jang, Jin; Lee, Yun Mi; Park, Hyojin; Lee, Hyeon Ju

doi:10.34250/jkccn.2019.12.1.36

Cited by 4 publications

(4 citation statements)

References 21 publications

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“…Globally, ICU readmission are estimated to range from 2% to 25%,[ 14 , 15 ] and is undoubtedly associated with poor outcomes. [ 6 , 7 , 10 ] Hence, the readmission rate within 48 hours has been utilized as a KPI that reflects the quality of care provided by the ICU.…”

Section: Discussionmentioning

confidence: 99%

Mortality Rates in Early versus Late Intensive Care Unit Readmission

Aletreby

Mady

Al-Odat

et al. 2023

Saudi Journal of Medicine &Amp; Medical Sciences

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Background: ICU readmission is associated with poor outcomes. Few studies have directly compared the outcomes of early versus late readmissions, especially in Saudi Arabia. Objective: To compare the outcomes between early and late ICU readmissions, mainly with regards to hospital mortality. Methods: This retrospective study included unique patients who, within the same hospitalization, were admitted to the ICU, discharged to the general wards, and then readmitted to the ICU of King Saud Medical City, Riyadh, Saudi Arabia, between January 01, 2015, and June 30, 2022. Patients readmitted within 2 calendar days were grouped into the Early readmission group, while those readmitted after 2 calendar days were in the Late readmission group. Results: A total of 997 patients were included, of which 753 (75.5%) belonged to the Late group. The mortality rate in the Late group was significantly higher than that in the Early group (37.6% vs. 29.5%, respectively; 95% CI: 1%–14.8%; P = 0.03). The readmission length of stay (LOS) and severity score of both groups were similar. The odds ratio of mortality for the Early group was 0.71 (95% CI: 0.51–0.98, P = 0.04); other significant risk factors were age (OR = 1.023, 95% CI: 1.016–1.03; P < 0.001) and readmission LOS (OR = 1.017, 95% CI: 1.009–1.026; P < 0.001). The most common reason for readmission in the Early group was high Modified Early Warning Score, while in the Late group, it was respiratory failure followed by sepsis or septic shock. Conclusion: Compared with late readmission, early readmission was associated with lower mortality, but not with lower LOS or severity score.

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Section: Discussionmentioning

confidence: 99%

Mortality Rates in Early versus Late Intensive Care Unit Readmission

Aletreby

Mady

Al-Odat

et al. 2023

Saudi Journal of Medicine &Amp; Medical Sciences

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“…Previous studies have shown that older age, male gender, ICU admission diagnosis, admission source, and the Acute Physiology and Chronic Health Evaluation (APACHE) score are related to unplanned ICU readmission (Jang et al, 2019; Liu et al, 2017; Kang, 2016; Ohnuma et al, 2018). In addition, continuous renal replacement therapy (CRRT), mechanical ventilation, time of ICU discharge, length of ICU stay, and presence of tracheostomy are also associated with ICU readmission (Jeong et al, 2019; Jo et al, 2015; Ohnuma et al, 2018; Ponzoni et al, 2017).…”

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confidence: 99%

“…Moreover, the main risk factors known to date have been mostly identified in Western studies, and there is no validated scoring system to predict readmission after ICU discharge (Desautels et al, 2017; Pedersen, Meyer, & Uhrenfeldt, 2017). The aforementioned studies suggest that the risk factors vary depending on the time elapsed between ICU discharge and readmission (Desautels et al, 2017; Jang et al, 2019; Lin et al, 2018). One potential explanation for this finding is the variability in the causes and timing of readmission.…”

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confidence: 99%

“…infections, ICU-acquired weakness, and delirium due to extended length of stay in the ICU (Ohnuma, Shinjo, Brookhart, & Fushimi, 2018;Omar, Shirazy, Omar, & Chaari, 2020;Sauro, Soo, Quan, & Stelfox, 2020). Currently, unplanned ICU readmission rates range from 2% to 25.8% worldwide (Jang, Lee, Park, & Lee, 2019;Liu et al, 2017;Ohnuma et al, 2018). Compared with patients admitted to the ICU for the first time, most readmitted patients have poorer prognosis (Lin, Chen, Chao, & Lai, 2018;Rosa, Roehrig, de Olivelra, & Maccari, 2015), require more hands-on care from the medical team (Lin et al, 2018), and show higher in-hospital mortality and longer hospital stays (Lin et al, 2018;Ohnuma et al, 2018).…”

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confidence: 99%

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Predictors of Early and Late Unplanned Intensive Care Unit Readmission: A Retrospective Cohort Study

Son

Kim

Lee

et al. 2021

J of Nursing Scholarship

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Purpose Intensive care unit (ICU) readmission is considered one of the major quality indicators of critical care. Reducing ICU readmission can improve patients’ outcomes and optimize health resources, but there are limited data on the predictors of unplanned ICU readmission. This study aimed to identify the risk factors associated with unplanned ICU readmission within 48 hr (early) and after 48 hr (late) from ICU discharge. Design Retrospective cohort study. Methods Data were collected from patients’ electronic medical records in a 24‐bed medical ICU at a tertiary academic medical center in Busan, South Korea. Among all the patients admitted to the medical ICU (n = 1,033) between January 2015 and December 2017, 739 eligible patients were analyzed. A multivariable multinomial logistic regression model was conducted to identify predictors of ICU readmission. Findings Out of the 739 patients analyzed, 66 (8.9%) were readmitted to the medical ICU: 13 (1.8%) as early readmission and 53 (7.1%) as late readmission. Two significant predictors were identified for early readmission: ICU admission from the ward (odds ratio [OR] = 4.14; 95% confidence interval [CI] 1.25, 13.67) and mechanical ventilation support >14 days (OR = 13.25; 95% CI 1.78, 98.89). For late ICU admission, there were four risk factors: ICU admission from the ward (OR = 2.69; 95% CI 1.44, 5.05), tracheostomy placement (OR = 3.58; 95% CI 1.49, 8.59), mechanical ventilation support >14 days (OR = 4.77; 95% CI 1.67, 13.63), and continuous renal replacement therapy (OR = 4.57; 95% CI 2.42, 8.63). Conclusions To prevent unplanned ICU readmission in patients at high risk, it is necessary to investigate further the role of clinical judgment and communication within the ICU clinical team and institutional‐level support regarding ICU readmission events. Clinical Relevance Both ICU nurses and nurses in post‐ICU settings should be aware of the potential risk factors associated with early and late ICU readmission. Predictors and readmission strategies may be different for early and late readmissions. Prospective multicenter studies are needed to examine how these factors influence post‐ICU outcomes.

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Early nutritional support for inpatients reduces admission rates to intensive care units in Korea: a single-center case-control study

Kim,

Yang,

Han

et al. 2024

Ann Clin Nutr Metab

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Purpose: Early nutritional support (ENS) for critically ill patients is promoted by many studies. However, there is a lack of data evaluating its necessity in general wards. This study aims to determine the impact of ENS on patients in general wards. Methods: Patients aged 18 and above, admitted to the Jeonbuk National University Hospital in Jeonju from January 2020 to December 2020, who were eligible for nutritional support and hospitalized for at least 7 days were included in the study. We divided the patients into two groups: the ENS group, who received nutritional support within 48 hours of admission, and the control group, who received it after 48 hours. Results: Among 1,077 patients, 146 met the inclusion criteria. The ENS group (n=38) and the control group (n=108) were compared retrospectively. There was a significant age difference between the two groups (P=0.028). The admission ratio to the intensive care unit (ICU) in the ENS group was significantly lower than that in the control group (10.2% vs. 26.3%, P=0.019). The calorie support rate (%) and protein support rate (%) in the ENS group were significantly higher than in the control group (50.12%±23.30% vs. 38.56%±18.02%, P=0.006; 44.61%±25.07% vs. 32.07%±22.76%, P=0.002, respectively). After propensity score matching, the ENS was significantly associated with ICU low admissions (odds ratio 0.08, 95% confidence interval 0.01-0.69, P=0.022). Conclusion:A future multi-center study considering underlying diseases is needed to provide additional scientific evidence to support the effects of ENS.

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The Risk Factors Related to Early Readmission to the Intensive Care Unit

Cited by 4 publications

References 21 publications

Mortality Rates in Early versus Late Intensive Care Unit Readmission

Mortality Rates in Early versus Late Intensive Care Unit Readmission

Predictors of Early and Late Unplanned Intensive Care Unit Readmission: A Retrospective Cohort Study

Early nutritional support for inpatients reduces admission rates to intensive care units in Korea: a single-center case-control study

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