Quality Improvement in the Intensive Care Unit (ICU): Baseline Readmission Characteristics From a Mixed Surgical ICU at a Tertiary Care Center

Abstract

PURPOSE: Over the last decade, there has been an increased focus on quality improvement within the ICU. One frequently suggested target for quality improvement focuses on readmission rates to the ICU, as prior clinical research has shown increased mortality, increased overall length of stay, and increased costs in patients readmitted to an ICU within one hospitalization[1-4]. METHODS: Prior to implementation of a quality improvement tool to decrease readmissions to a surgical ICU, baseline characteristics over a six month period in 2012 were reviewed as a benchmarking process. Two physicians independently reviewed each readmission and determined if the event was preventable. Disagreements were resolved by discussion between the reviewers. RESULTS: The analysis indicated that over the six month time frame, there were 65 total readmissions, including readmissions to a different ICU within the institution. Fifty-five of the readmissions returned to the same ICU, 8 were admitted to a medical ICU, 1 to a neurological ICU and 1 different surgical ICU. Forty-four of the 65 readmissions were determined to be unplanned readmissions upon review by two independent physicians. Of the 44 unplanned readmissions, 17 were determined to be potentially preventable with 89% interobserver agreement (free margin kappa = 0.79). Upon further review, 33.8% of readmissions were a direct result of a rapid-response team call with hypoxia, hypotension and post-respiratory/cardiac arrest as the top three reasons. CONCLUSIONS: In summary, this analysis provided meaningful insight into factors that may contribute to unplanned readmissions within a surgical ICU.