JOURNAL ARTICLE

Intensive care unit readmissions in U.S. hospitals: patient characteristics, risk factors, and outcomes

Andrew A Kramer, Thomas L Higgins, Jack E Zimmerman
Critical Care Medicine 2012, 40 (1): 3-10
21926603

OBJECTIVE: To examine which patient characteristics increase the risk for intensive care unit readmission and assess the association of readmission with case-mix adjusted mortality and resource use.

DESIGN: : Retrospective cohort study.

SETTING: Ninety-seven intensive and cardiac care units at 35 hospitals in the United States.

PATIENTS: A total of 229,375 initial intensive care unit admissions during 2001 through 2009 who met inclusion criteria.

INTERVENTIONS: None.

MEASUREMENTS AND MAIN RESULTS: For patients who were discharged alive and candidates for readmission, we compared the characteristics of those with and without a readmission. A multivariable logistic regression analysis was used to identify potential patient-level characteristics that increase the risk for subsequent readmission. We also evaluated case-mix adjusted outcomes by comparing observed and predicted values of mortality and length of stay for patients with and without intensive care unit readmission. Among 229,375 first admissions that met inclusion criteria, 13,980 (6.1%) were eventually readmitted. Risk factors associated with the highest multivariate odds ratio for unit readmission included location before intensive care unit admission, age, comorbid conditions, diagnosis, intensive care unit length of stay, physiologic abnormalities at intensive care discharge, and discharge to a step-down unit. After adjustment for risk factors, patients who were readmitted had a four-fold greater probability of hospital mortality and a 2.5-fold increase in hospital stay compared to patients without readmission.

CONCLUSIONS: Intensive care readmission is associated with patient factors that reflect a greater severity and complexity of illness, resulting in a higher risk for hospital mortality and a longer hospital stay. To improve patient safety, physicians should consider these risk factors when making intensive care discharge decisions. Because intensive care unit readmission correlates with more complex and severe illness, readmission rates require case-mix adjustment before they can be properly interpreted as quality measures.

Full Text Links

Find Full Text Links for this Article

Discussion

You are not logged in. Sign Up or Log In to join the discussion.

Related Papers

Remove bar
Read by QxMD icon Read
21926603
×

Save your favorite articles in one place with a free QxMD account.

×

Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"