Unplanned Readmission to Intensive Care Unit during the same Hospitalization at a Teaching Hospital

Song, Dong-Hyun; Lee, Sun-Gyo; Kim, Chui-Gyu; Choi, Dong-Ju; Lee, Sang-Il; Park, Su-Kil

Journal of Korean Society Quality Assurance Health Care 2003;10(1): 28.
Published online May 30, 2003.

계획에 없던 중환자실 재입실 실태 및 원인

송동현¹, 이순교¹, 김철규¹, 최동주², 이상일¹, 박수길¹

¹서울아산병원 CPI팀
²서울아산병원 의료정보팀

Unplanned Readmission to Intensive Care Unit during the same Hospitalization at a Teaching Hospital

Dong-Hyun Song¹, Sun-Gyo Lee¹, Chui-Gyu Kim¹, Dong-Ju Choi², Sang-Il Lee¹, Su-Kil Park¹

¹Clinical Performance Improvement Team, Asan Medical Center
²Information Management Department, Asan Medical Center

Abstract

Background
Because unplanned readmissions to intensive care unit(ICU)might be related with undesirable patient outcomes, we investigated the pattern of and reason for unplanned ICU readmission to provide baseline data for reducing unplanned returns to ICU.
Methods
The subjects included all patients who readmitted to ICU during the same hospitalization at a tertiary referral hospital between January 1st and June 30th 2002. Quality improvement(QI) nurse collected the data through medical records and a medical director reviewed the data collected.
Results
1) The average unplanned ICU readmission rate was 5.6%(gastroenterology 14.6%, pediatrics 12.7%, pulmonology 11.9%, neurosurgery 6.3%, general surgery 5.3%, chest surgery 3.9%, and cardiology 3.3%). 2) Among the unplanned readmissions, more than 50% of cases were from patients older than 60 years, and the main categories of diagnose at hospital admission were neurologic disease(29.9%) and cardiovascular disease(27.6%). 3) Of unplanned ICU readmissions, 41.8% had recurrence of the initial problems, 44.8% had occurrence of new problems. And 9.7% required post-operative care after unplanned operations. 4) The most common cause responsible for unplanned ICU readmission were respiratory problem(38.3%) and cardiovascular problem(14.3%). 5) About 40% of unplanned ICU readmission occurred within 3 days after ICU discharge. 6) Average length of stay of the readmitted patients to ICUs were much longer than that of non-readmitted patients. 7) Hospital mortality rate was much higher for unplanned ICU readmitted patients(23.6%) than for non-readmitted patients(1.5%) (P<0.001). Conclusions : This study showed that the unplanned ICU readmitted patients had poor outcomes(high morality and increased length of stay). In addition study results suggest that more attention should be paid to patients in ICU with poor respiratory function or elderly patients, and careful clinical decisions are required at discharged from ICU to general ward.

Key words Unplanned ICU readmission;