Journal of Korean Critical Care Nursing (중환자간호학회지)

Korean Society of Critical Care Nursing (한국중환자간호학회)
권호 표지

Case Control Study Identifying the Predictors of Unplanned Intensive Care Unit Readmission After Discharge

집중치료실 퇴실환자의 비계획성 재입실 예측 인자를 규명하기 위한 사례대조군 연구

  • Received : 2018.08.13
  • Accepted : 2018.09.17
  • Published : 2018.10.31
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Abstract

Purpose : This study was performed to identify the influencing factors of unplanned intensive care unit (ICU) readmission. Methods : The study adopted a Rretrospective case control cohort design. Data were collected from the electronic medical records of 844 patients who had been discharged from the ICUs of a university hospital in Incheon from June 2014 to December 2014. Results : The study found the unplanned ICU readmission rate was to be 6.4%(n=54). From the univariate analysis revealed that, major symptoms at $1^{st}$ ICU admission, severity at $1^{st}$ ICU admission (CPSCS and APACHE II), duration of applying ventilator application during $1^{st}$ ICU admission, severity at $1^{st}$ discharge from ICU (CPSCS, APACHE II, and GCS), and application of $FiO_2$ with oxygen therapy, implementation of sputum expectoration methods, and length of stay of ICU at $1^{st}$ ICU discharge were appeared to be significant; further, decision tree model analysis revealed that while only 4 variables (sputum expectoration methods, length of stay of ICU, $FiO_2$ with oxygen therapy at $1^{st}$ ICU discharge, and major symptoms at $1^{st}$ ICU admission) were shown to be significant. Conclusions : Since sputum expectoration method was the most important factor to predictor of unplanned ICU readmission, a assessment tool for the patients' capability of sputum expectoration needs to should be developed and implemented, and standardized ICU discharge criteria, including the factors identified from the by empirical evidences, might should be developed to decrease the unplanned ICU readmission rate.

Keywords

References

  1. Anthonisen, N. R. (2009). Retrospective studies. Canadian Respiratory Journal, 16 (4), 117-118. https://doi.org/10.1155/2009/704292
  2. Brown, S. E., Ratcliffe, S. J., Kahn, J. M., & Halpern, S. D. (2012). The epidemiology of intensive care unit readmissions in the United States. American Journal of Respiratory and Critical Care Medicine, 185 (9), 955-964. https://doi.org/10.1164/rccm.201109-1720OC
  3. Cho, J. (2014). What intensive care unit readmission means. Allergy, Asthma & Respiratory Disease, 2 (2), 83-84. https://doi.org/10.4168/aard.2014.2.2.83
  4. Choi, E. Y. (2006). A study on the related factors of readmission to intensive care unit (Unpublished master's thesis). Seoul National University, Seoul, Korea.
  5. Choi, J. H., Kang, H. C., Kim, E. S., Lee, S. K., Han, S. T., & Kim, M. K. (2002). Prediction and excess of data mining using decision tree analysis. Seoul: SPSS Academy.
  6. Elliott, M. (2006). Readmission to intensive care: A review of the literature. Australian Critical Care, 19 (3), 96-104. https://doi.org/10.1016/S1036-7314(06)80004-4
  7. Gajic, O., Malinchoc, M., Comfere, T. B., Harris, M. R., Achouiti, A., Yilmaz, M., & Farmer, J. C. (2008). The stability and workload index for transfer score predicts unplanned intensive care unit patient readmission: Initial development and validation. Critical Care Medicine, 36 (3), 676-682. https://doi.org/10.1097/CCM.0B013E318164E3B0
  8. Han, D. W., Koh, S. O., & Lee, M. W. (2003). Clinical features and risk factors of patients readmission to ICU. Korean Journal of Anesthesiology, 44 (1), 78-83. https://doi.org/10.4097/kjae.2003.44.1.78
  9. Hardy, K. A., Bach, J. R., Stoller, J. K., Hill, N. S., Make, B., Celli, B. R., & Leger, P. (1994). A review of airway clearance: New techniques, indications, and recommendations. Respiratory Care, 39 (5), 440-455.
  10. Health Insurance Review & Assessment Service data. (2016). The quality assessment of ICU. Retrieved May 16, 2016, from https://www.hira.or.kr/download.do?src...14.pdf&fnm=2016 _14.pdf.pdf
  11. Hosein, F. S., Bobrovitz, N., Berthelot, S., Zygun, D., Ghali, W. A., & Stelfox, H. T. (2013). A systematic review of tools for predicting severe adverse events following patient discharge from intensive care units. Critical Care, 17 (3), R102. https://doi.org/10.1186/cc12747
  12. Huh, M. H., & Lee, Y. G. (2008). Data mining modeling and case (2nd ed.). Seoul: Hannarae.
  13. Kim, K. S., & Kim, K. H. (2010). A prediction model for internet game addiction in adolescents: Using a decision tree analysis. Journal of Korean Academy of Nursing, 40 (3), 378-388. https://doi.org/10.4040/jkan.2010.40.3.378
  14. Kim, S. E., & Kim, S. A. (2013). A predictive model of depression in rural elders-decision tree analysis. Journal of Korean Academy of Nursing, 43 (3), 442-451. https://doi.org/10.4040/jkan.2013.43.3.442
  15. Kim, Y. J., & Kim, K. S. (2013). Risk factors of unplanned readmission to intensive care unit. Journal of Korea Clinical Nursing Research, 19 (2), 265-274. https://doi.org/10.22650/JKCNR.2013.19.2.265
  16. Kim, B. Y. (2015). Predictors of protective factors for depression in adolescent using decision making tree analysis. The Journal of the Korea Contents Association, 15 (5), 375-385. https://doi.org/10.5392/JKCA.2015.15.05.375
  17. Kramer, A. A., Higgins, T. L., & Zimmerman, J. E. (2013). The association between ICU readmission rate and outcomes. Critical Care Medicine, 41(1), 24-33. https://doi.org/10.1097/CCM.0b013e3182657b8a
  18. Lee, J. Y. (2008). Development of a prediction model for ICU readmission as a quality indicator (Unpublished master's thesis). Seoul National University, Seoul, Korea.
  19. Linton, S., Grant, C., Pellegrini, J., & Davidson, A. (2009). The development of a clinical markers score to predict readmission to pediatric intensive care. Intensive and Critical Care Nursing, 25 (6), 283-293. https://doi.org/10.1016/j.iccn.2009.07.003
  20. Lin, W. T., Chen, W. L., Chao, C. M., & Lai, C. C. (2018). The outcomes and prognostic factors of the patients with unplanned intensive care unit readmissions. Medicine, 97 (26), e11124. https://doi.org/10.1097/MD.0000000000011124
  21. Niven, D. J., Bastos, J. F., & Stelfox, H. T. (2014). Critical care transition programs and the risk of readmission or death after discharge from an ICU: A systematic review and meta-analysis. Critical Care Medicine, 42(1), 179-187. https://doi.org/10.1097/CCM.0b013e3182a272c0
  22. Ofoma, U. R., Chandra, S., Kashyap, R., Herasevich, V., Ahmed, A., Gajic, O., & Farmer, C. J. (2014). Findings from the implementation of a validated readmission predictive tool in the discharge workflow of a medical intensive care unit. Annals of the Ame- rican Thoracic Society, 11(5), 737-743. https://doi.org/10.1513/AnnalsATS.201312-436OC
  23. Ponzoni, C. R., Correa, T. D., Filho, R. R., Serpa Neto, A., Assuncao, M. S., Pardini, A., & Schettino, G. P. (2017). Readmission to the intensive care unit: Incidence, risk factors, resource use, and outcomes. A retrospective cohort study. Annals of the American Thoracic Society, 14 (8), 1312-1319. https://doi.org/10.1513/AnnalsATS.201611-851OC
  24. Rhodes, A., Moreno, R. P., Azoulay, E., Capuzzo, M., Chiche, J. D., Eddleston, J., & Kuhlen, R. (2012). Prospectively defined indicators to improve the safety and quality of care for critically ill patients: A report from the task force on safety and quality of the european society of intensive care medicine (ESICM). Intensive Care Medicine, 38 (4), 598-605. https://doi.org/10.1007/s00134-011-2462-3
  25. Rosenberg, A. L., & Watts, C. (2000). Patients Readmission to ICUs: A systematic review of risk factors and outcomes. Chest, 118 (2), 492-502. https://doi.org/10.1378/chest.118.2.492
  26. Rosenberg, A. L., Hofer, T. P., Hayward, R. A., Strachan, C., & Watts, C. M. (2001). Who bounces back? Physiologic and other predictors of intensive care unit readmission. Critical Care Medicine, 29 (3), 511-518. https://doi.org/10.1097/00003246-200103000-00008
  27. Song, D. H., Lee, S. G., Kim, C. G., Choi, D. J., Lee, S. I., & Park, S. K. (2003). Unplanned readmission to intensive care unit during the same hospitalization at a teaching hospital. Journal of Korean Society of Quality Assurance in Health Care, 10 (1), 28-41.
  28. Wong, E. G., Parker, A. M., Leung, D. G., Brigham, E. P., & Arbaje, A. I. (2016). Association of severity of illness and intensive care unit readmission: A systematic review. Heart & Lung, 45 (1), 3-9. https://doi.org/10.1016/j.hrtlng.2015.10.040