Unplanned early readmission to the intensive care unit: A case-control study of patient, intensive care and ward-related factors

Makris, N., Dulhunty, J. M., Paratz, J., Bandeshe, H. and Gowardman, J. (2010) Unplanned early readmission to the intensive care unit: A case-control study of patient, intensive care and ward-related factors. Anaesthesia and Intensive Care, 38 4: 723-731.

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Author Makris, N.
Dulhunty, J. M.
Paratz, J.
Bandeshe, H.
Gowardman, J.
Title Unplanned early readmission to the intensive care unit: A case-control study of patient, intensive care and ward-related factors
Journal name Anaesthesia and Intensive Care   Check publisher's open access policy
ISSN 0310-057X
1448-0271
Publication date 2010-07
Sub-type Article (original research)
Volume 38
Issue 4
Start page 723
End page 731
Total pages 9
Editor Neville M. Gibbs
Jeanette Thirlwell
Place of publication Melbourne, VIC, Australia
Publisher Australian Association of Anaesthetists
Collection year 2011
Language eng
Formatted abstract
The purpose of this study was to identify patient, intensive care and ward-based risk factors for early, unplanned readmission to the intensive care unit. A five-year retrospective case-control study at a tertiary referral teaching hospital of 205 cases readmitted within 72 hours of intensive care unit discharge and 205 controls matched for admission diagnosis and severity of illness was conducted. The rate of unplanned readmissions was 3.1% and cases had significantly higher overall mortality than control patients (odds ratio [OR] 4.7, 95% confidence interval [CI] 2.1 to 10.7). New onset respiratory compromise and sepsis were the most common cause of readmission. Independent risk factors for readmission were chronic respiratory disease (OR 3.7, 95% CI 1.2 to 12,P=0.029), pre-existing anxiety/depression (OR 3.3, 95% CI 1.7 to 6.6, P <0.001), international normalised ratio >1.3 (OR 2.3, 95% CI 1.1 to 4.9, P=0.024), immobility (OR 2.3, 95% CI 1.4 to 3.6, P=0.001), nasogastric nutrition (OR 2.0, 95% CI 1.0 to 4.0, P=0.041), a white cell count >15×109/l (OR 2.0, 95% CI 1.2 to 3.4, P=0.012) and non-weekend intensive care unit discharge (OR 1.9, 95% CI 1.1 to 3.5,P=0.029). Physiological derangement on the ward (OR 26, 95% CI 8.0 to 81, P <0.001) strongly predicted readmission, although only 20% of patients meeting medical emergency team criteria had a medical emergency team call made. Risk of readmission is associated with both patient and intensive care factors. Physiological derangement on the ward predicts intensive care unit readmission, however, clinical response to this appears suboptimal.
Keyword Intensive care ward
Medical emergency team
Readmission
Respiratory disease
Sepsis
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes Issue misdated Vol. 38, No. 3, May 2010.

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2011 Collection
School of Health and Rehabilitation Sciences Publications
School of Medicine Publications
 
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Created: Tue, 01 Mar 2011, 15:38:37 EST by Dr Jennifer Paratz on behalf of Anaesthesiology and Critical Care - RBWH