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Observational Study
. 2013 Mar;25(1):32-8.
doi: 10.1590/s0103-507x2013000100007.

Readmissions and deaths following ICU discharge: a challenge for intensive care

[Article in English, Portuguese]
Tatiane Gomes de Araujo  1 , Marcelo de Mello Rieder, Fernanda Machado Kutchak, João Wilney Franco Filho
Affiliations
Observational Study

Readmissions and deaths following ICU discharge: a challenge for intensive care

[Article in English, Portuguese]
Tatiane Gomes de Araujo et al. Rev Bras Ter Intensiva. 2013 Mar.

Abstract
in English, Portuguese

Objectives: Identify patients at risk for intensive care unit readmission, the reasons for and rates of readmission, and mortality after their stay in the intensive care unit; describe the sensitivity and specificity of the Stability and Workload Index for Transfer scale as a criterion for discharge from the intensive care unit.

Methods: Adult, critical patients from intensive care units from two public hospitals in Porto Alegre, Brazil, comprised the sample. The patients' clinical and demographic characteristics were collected within 24 hours of admission. They were monitored until their final outcome on the intensive care unit (death or discharge) to apply the Stability and Workload Index for Transfer. The deaths during the first intensive care unit admission were disregarded, and we continued monitoring the other patients using the hospitals' electronic systems to identify the discharges, deaths, and readmissions.

Results: Readmission rates were 13.7% in intensive care unit 1 (medical-surgical, ICU1) and 9.3% in intensive care unit 2 (trauma and neurosurgery, ICU2). The death rate following discharge was 12.5% from ICU1 and 4.2% from ICU2. There was a statistically significant difference in Stability and Workload Index for Transfer (p<0.05) regarding the ICU1 patients' outcome, which was not found in the ICU2 patients. In ICU1, 46.5% (N=20) of patients were readmitted very early (within 48 hours of discharge). Mortality was high among those readmitted: 69.7% in ICU1 and 48.5% in ICU2.

Conclusions: The Stability and Workload Index for Transfer scale showed greater efficacy in identifying patients more prone to readmission and death following discharge from a medical-surgical intensive care unit. The patients' intensive care unit readmission during the same hospitalization resulted in increased morbidity, mortality, length of stay, and total costs.

Objetivo: Identificar os pacientes com risco de retornar à unidade de terapia intensiva, os motivos e as taxas de readmissão, e a mortalidade após a estadia na unidade de terapia intensiva; além de descrever a sensibilidade e a especificidade da escala Stability and Workload Index for Transfer como critério de alta da unidade de terapia intensiva.

Métodos: Pacientes adultos críticos de unidades de terapia intensiva de dois hospitais públicos de Porto Alegre (RS) compuseram a amostra. Nas primeiras 24 horas de internação, foram obtidas informações clínicas e demográficas dos pacientes. Eles eram monitorados até seu destino final na unidade de terapia intensiva (óbito ou alta) para a realização do Stability and Workload Index for Transfer. Os óbitos durante a primeira admissão na unidade de terapia intensiva foram desconsiderados, seguindo-se com o acompanhamento dos demais pacientes, pelo sistema eletrônico dos hospitais, para a identificação das altas, óbitos e readmissões.

Resultados: As taxas de readmissão foram 13,7% na unidade de terapia intensiva 1 - clínica cirúrgica (UTI1) e 9,3% na unidade de terapia intensiva 2 - trauma e neurocirurgia (UTI2); as mortes após a alta da unidade de terapia intensiva foram 12,5% na UTI1 1 e 4,2% na UTI2. Houve diferença estatística significativa do Stability and Workload Index for Transfer (p<0,05) nos pacientes da UTI1 em relação ao desfecho, o que não se repetiu nos da UTI2. Na UTI1 46,5% (N=20) dos pacientes foram readmitidos de forma precoce (em menos de 48 horas de alta). A mortalidade entre os readmitidos foi alta, 69,7% (UTI1) e 48,5% (UTI2).

Conclusão: A escala Stability and Workload Index for Transfer apresentou maior eficácia em reconhecer os pacientes mais propensos à readmissão e a óbitos após a alta em uma unidade de terapia intensiva clínica-cirúrgica. A readmissão dos pacientes na unidade de terapia intensiva, durante a mesma hospitalização, resultou em aumento da morbidade e mortalidade, de tempo de permanência e de custos totais.

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Conflict of interest statement

Conflicts of interest: None.

Figures

Figure 1
Figure 1
Stability and Workload Index for Transfer (SWIFT) scale ROC curves. (A) Intensive Care Unit 1. (B) Intensive Care Unit 2. A: Area under the curve = 0.670±0.34; p<0.001 and 95% CI=0.603-0737; B: Area under the curve = 0.577±0.041; p=0.085; 95% CI=0.496-0.658.
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