DR. TAM Oi-Yan, MBBS(HK) MRCP(UK) PDipID(HK); Department of Intensive Care, Pamela Youde Nethersole Eastern Hospital, Hong Kong
Objective: To evaluate the pattern of readmission to intensive care unit (ICU) in a local hospital and identify patients at risk of unplanned ICU readmission.
Design: A single-center nested case-control study in a mixed medical-surgical adult intensive care unit in a tertiary regional hospital
Interventions: None
Measurements and main results: Total 146 patients with unplanned readmission to the ICU of Pamela Youde Nethersole Eastern Hospital between 1 January 2008 and 30 June 2010 were studied and compared to 292 control patients who were discharged from ICU alive and never readmitted during the same hospitalization. Case and control were matched for age, gender and Acute Physiology and Chronic Health Evaluation (APACHE) IV risk of death. Patients’ demographics parameters, physiological status and laboratory data were collected. Reason for readmission was determined from the medical record. During this 30-month period, the ICU readmission rate was 5.13% and the early readmission rate (defined as readmission within 72 hours of ICU discharge) was 2.32%. Mortality in readmitted patients was 30.8% compared to 6.8% in control (p<0.001). Mean hospital length of stay of readmitted group was 3 times of control (67.25 66.43 Vs 22.16 25.04 days, p<0.001). Deterioration of respiratory condition was the commonest cause of ICU readmission. Based on tree analysis, post-operative patients with sepsis (adjusted p=0.043), non-post-operative septic patients with significant fluid gain 24 hours before ICU discharge (adjusted p=0.013) and non-septic patient presented with increased sputum quantity on ICU discharge (adjusted p=0.012) were significantly associated with ICU readmission. In logistic regression analysis, presence of pneumonia during index admission was associated with ICU readmission due to worsening of pre-existing condition (adjusted OR=5.638, 95% C.I. 2.260-14.069, p=0.002).
Conclusion: The result highlighted the importance of good pulmonary care of critically ill patients. Incomplete resolution of respiratory conditions remained an important reason for potentially preventable ICU readmission. Attention to patient’s fluid balance and sputum quantity before ICU discharge might help to prevent unplanned ICU readmission.
Keywords: critical care, patient readmission, patient discharge, case-control studies, hospital mortality, sepsis, respiratory therapy, water-electrolyte balance.