Hospital Readmission and Post-Acute Care Use After Intensive Care Unit Admissions: New ICU Quality Metrics?

Objective: Care coordination is a national priority. Post-acute care use and hospital readmission appear to be common after critical illness. It is unknown whether specialty critical care units have different readmission rates and what these trends have been over time. Methods: In this retrospective cohort study, a cohort of 53,539 medical/surgical patients who were treated in a critical care unit during their index admission were compared with 209,686 patients who were not treated in a critical care unit. The primary outcome was 30-day all cause hospital readmission. Secondary outcomes included post-acute care resource use and immediate readmission, defined as within 7 days of discharge. Results: Compared to patients discharged after an index hospitalization without critical illness, surviving patients following ICU admission were not more likely to be rehospitalized within 30 days (15.8 vs. 16.1%, p = 0.08). However, they were more likely to receive post-acute care services (45.3% vs. 70.9%, p < 0.001) as well as be rehospitalized within 7 days (5.2 vs. 6.0%, p < 0.001). Post-acute care use and 30-day readmission rates varied by ICU type, the latter ranging from 11.7% after admission in a cardiothoracic critical care unit to 23.1% after admission in a medical critical care unit. 30-day readmission after ICU admission did not decline between 2010 and 2015 (p = 0.38). Readmission rates declined over time for 2 of 4 targeted conditions (heart failure and chronic obstructive pulmonary disease), but only when the hospitalization did not include ICU admission. Conclusions: Rehospitalization for survivors following ICU admission is common across all specialty critical care units. Post-acute care use is also common for this population of patients. Overall trends for readmission rates after critical illness did not change over time, and readmission reductions for targeted conditions were limited to hospitalizations that did not include an ICU admission.

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Role of Transitional Care Measures in the Prevention of Readmission After Critical Illness

Critical Care Nurse ◽

10.4037/ccn2017218 ◽

2017 ◽

Vol 37 (1) ◽

pp. e10-e17 ◽

Cited By ~ 3

Author(s):

Jessica S. Peters

Keyword(s):

Critical Care ◽

Critical Illness ◽

Critical Care Unit ◽

Transitional Care ◽

Discharge Planning ◽

Surgical Care ◽

Care Needs ◽

Readmission Rates ◽

Increased Risk ◽

Poor Outcomes

Transitioning from the critical care unit to the medical-surgical care area is vital to patients’ recovery and resolution of critical illness. Such transitions are necessary to optimize use of available hospital resources to meet patient care needs. One in 10 patients discharged from the intensive care unit are readmitted to the unit during their hospitalization. Critical care readmission is associated with significant increases in illness acuity, overall length of stay, and health care costs as well as a potential 4-fold increased risk of mortality. Patients with complex illness, multiple comorbid conditions, and a prolonged initial stay in the critical care unit are at an increased risk of being readmitted to the critical care unit and experiencing poor outcomes. Implementing nurse-driven measures that support continuity of care and consistent communication practices such as critical care outreach services, transitional communication tools, discharge planning, and transitional care units improves transitions of patients from the critical care environment and reduces readmission rates.

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Rabies in the Critical Care Unit: Diagnostic and Therapeutic Approaches

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/s0317167100054056 ◽

2011 ◽

Vol 38 (5) ◽

pp. 689-695 ◽

Cited By ~ 10

Author(s):

Alan C. Jackson

Keyword(s):

Critical Care ◽

Critical Care Unit ◽

Virus Antigen ◽

Rabies Vaccine ◽

Human Rabies ◽

Therapeutic Approaches ◽

Rna Detection ◽

Critical Care Units ◽

Antiviral Therapies ◽

History Of

ABSTRACT:Worldwide, human rabies is prevalent where there is endemic dog rabies, but the disease may present unexpectedly in critical care units when suggestive clinical features have passed. In North America transmission from bats is most common and there is often no history of a bat bite or even contact with bats. Laboratory diagnostic evaluation for rabies includes serology plus skin biopsy, cerebrospinal fluid, and saliva specimens for rabies virus antigen and/or RNA detection. Rare patients have survived rabies, and most received rabies vaccine prior to the onset of illness. Therapeutic coma (midazolam and phenobarbital), ketamine, and antiviral therapies (dubbed the "Milwaukee Protocol") were given to a rabies survivor, but this therapy was likely not directly responsible for the favorable outcome. There have been many subsequent failures of similar therapeutic approaches. There is no scientific rationale for the use of therapeutic coma in human rabies. New approaches to treating human rabies need to be developed.

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Maternal critical care

Oxford Textbook of Medicine ◽

10.1093/med/9780198746690.003.0281 ◽

2020 ◽

pp. 2701-2705

Author(s):

Rupert Gauntlett

Keyword(s):

Critical Care ◽

Critical Illness ◽

Death Rate ◽

Critical Care Unit ◽

Post Partum ◽

The United Kingdom ◽

The World ◽

Resource Poor ◽

Acute Fatty Liver

Critical illness during pregnancy or after giving birth is rare: in the United Kingdom 0.29% of maternities involve admission to a critical care unit, and the maternal death rate is 0.01%. Over 80% of obstetric admissions to critical care occur in the post-partum phase, mainly due to complications relating to massive haemorrhage. Other pregnancy specific conditions that may require critical care support include pre-eclampsia (typically when diagnosis and treatment have been delayed), amniotic fluid embolism, peri-partum cardiomyopathy, and acute fatty liver of pregnancy. Puerperal sepsis remains a major problem in resource-poor parts of the world. Pregnant women who survive critical illness may be particularly prone to long-term psychological morbidity. It is vital that, once physiological stability has been achieved, no time is wasted before a mother is reunited with her baby.

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Costs and Resource Utilization in Prolonged Critical Illness

10.1093/med/9780199653461.003.0008 ◽

2014 ◽

Author(s):

Christopher E Cox

Keyword(s):

Health Care ◽

Critical Illness ◽

Acute Care ◽

Patient Population ◽

Health Care Policy ◽

Patient Flow ◽

Prolonged Mechanical Ventilation ◽

Post Discharge ◽

Chronic Critical Illness ◽

Post Acute Care

Patients who have chronic critical illness, operationally defined as those requiring prolonged mechanical ventilation, are markedly increasing in number and commonly experience profound, persistent physical and psychological debilitation. This patient population consumes an extraordinary amount of health care resources attributed to both the acute hospitalization as well as complex post-discharge treatments provided across multiple post-acute care facilities. Currently, the US health care system incentivizes these patient flow dynamics. Health care policy changes addressing post-acute care payment are inevitable. This chapter highlights potential patient, family, physician, and systems targets for current and future interventions, designed to improve quality and reduce costs for this patient population.

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The patient within the critical care environment

10.1093/med/9780199696260.003.0003 ◽

2017 ◽

Author(s):

Sheila Adam ◽

Sue Osborne ◽

John Welch

Keyword(s):

Critical Care ◽

Critical Illness ◽

Infection Control ◽

Critically Ill Patients ◽

Critical Care Unit ◽

Holistic Approach ◽

Care Environment ◽

The Common ◽

Prolonged Stress ◽

Dying Patient

Both critical illness and treatment in the critical care unit are extremely stressful, presenting great physical and psychological challenges for patients and their families. There are a range of compensatory responses to stress which may be adaptive, but severe or prolonged stress can induce a destructive spiral of decompensation. The importance of a holistic approach to care cannot be overemphasized; this chapter sets out the priorities of care for critically ill patients, and the common needs and problems for both patients and their families. The issues discussed include the mechanisms of stress in critical illness, the promotion of sleep, use of analgesia and sedation, management of delirium, complications of immobility, mouth, eye, and skin care, infection control, requirements for safe transfer, and care of the dying patient.

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A comparison of three methods in categorizing functional status to predict hospital readmission across post-acute care

PLoS ONE ◽

10.1371/journal.pone.0232017 ◽

2020 ◽

Vol 15 (5) ◽

pp. e0232017

Author(s):

Chih-Ying Li ◽

Amol Karmarkar ◽

Yong-Fang Kuo ◽

Hemalkumar B. Mehta ◽

Trudy Mallinson ◽

...

Keyword(s):

Functional Status ◽

Acute Care ◽

Hospital Readmission ◽

Post Acute Care

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Overview of Family Needs after Critical Illness: From Assessment to Intervention

AACN Advanced Critical Care ◽

10.4037/15597768-1991-2006 ◽

1991 ◽

Vol 2 (2) ◽

pp. 220-226 ◽

Cited By ~ 19

Author(s):

Jane Stover Leske

Keyword(s):

Critical Care ◽

Critical Illness ◽

Critically Ill ◽

Critical Care Nurses ◽

Nursing Interventions ◽

Family Needs ◽

Analysis Of Results ◽

Family Centered ◽

Primary Family ◽

Over Time

Results of numerous independent studies suggest that families of a critically ill hospitalized member have similar needs that they can readily identify as very important. Empirical analysis of results compiled from many studies across patient populations, settings, geographic locations, and over time indicates that families have primary needs for assurance, proximity, and information. These primary family needs provide a research-based framework to guide critical care nurses in implementing and evaluating family-centered nursing interventions

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Factors Associated with Perceived Stressors among Critical Care Units Adult Patients: An Exploratory Study

Journal of Pharmaceutical Research International ◽

10.9734/jpri/2021/v33i43b32545 ◽

2021 ◽

pp. 204-209

Author(s):

Swapnil Rahane ◽

Roma Patel ◽

Devrajsingh Chouhan

Keyword(s):

Critical Care ◽

Health Care Professionals ◽

Critical Care Unit ◽

Sampling Technique ◽

Adult Patients ◽

Exploratory Research ◽

Related Complication ◽

Early Recovery ◽

Financial Problems ◽

Critical Care Units

The critical care unit environment has been observed as a leading stressor not only amongst the health care professionals but in patients also. Unfamiliar surroundings, dependency on others, financial problems, etc. are among factors that are responsible for the development of stress in the patients admitted to the critical care units. Stress and its factors are also responsible for the patient's deliberate recovery and depraved prognosis. In this study, we explored the association between selective factors and perceived stressors among adult patients admitted to critical care units. A quantitative, exploratory research design study was conducted, to identify the association between the perceived stressors and selected factors of adult patients admitted in Critical Care Units of the selected multispecialty hospitals at Vadodara. A total of sixty patients admitted to the critical care departments were selected through the convenience sampling technique. A demographic variables datasheet and hospitals stress rating interview scale was used after the expert’s content validation to collect the data. Analysis and interpretation of data were done by using descriptive and inferential statistics. Results: Study findings revealed that all the patients, who were interviewed through the hospital stress interview scale, expressed the perception of stressors as indicated by the total perceived stressors score of above (1%). The study also revealed that separation from family members or spouses and financial problems are the highly rated perceived stressors among the patients admitted to the critical care unit. Patients also reported the least perceived stressful area was the problem with medication. There was a significant association between the socioeconomic status and medical-surgical diagnosis of patients with perceived stressors. Conclusion: Therefore, the findings of the study concluded that the study, patients admitted in the critical care department also suffer from stress due to some stressors, and it affects their prognosis and early recovery. Nursing professionals need to focus on the subjective characteristics of patients so that perceived stressors and early detection of the related complication can be prevented.

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