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ABSTRACT: To determine the epidemiology, in-hospital mortality, trends, patient characteristics and predictors of intensive care unit (ICU) readmission in Australia.
A retrospective longitudinal study of data for 38 Australian ICUs extracted from the Australian and New Zealand Intensive Care Society Adult Patient Database (ANZICS-ADP) for the years 2000-2007. Demographic, diagnostic, physiological and outcome data were analysed. A multivariate model was constructed to identify risk factors for ICU readmission. Outcomes examined included observed and risk-adjusted in-hospital mortality.
A total of 247,103 patients were discharged alive from their first ICU admission; 13,598 (5.5%) were readmitted at least once. Variables associated with an odds ratio greater than 1.05 for readmission (p < 0.001) were an initial ICU admission source other than elective surgery, any chronic health variable on severity scoring, tertiary hospital ICU and discharge between 6 p.m. and 6 a.m. Five initial diagnoses were associated with an odds ratio (OR) greater than 2 for readmission (p < 0.001). In-hospital mortality in readmitted patients was 20.7% compared with 4.4% in those not readmitted. Readmission rates have not changed over the study period. After adjustment for illness severity and readmission propensity, ICU readmission remained significantly associated with in-hospital mortality (OR 5.4, 95%, confidence interval (CI) 5.1-5.7).
Many risk factors for increased ICU readmission were identified in this study including ICU discharge between 6 p.m. and 6 a.m. This was the only modifiable variable studied. Prospective studies are required to identify other factors and to determine whether interventions may reduce ICU readmission and its high associated in-hospital mortality.
European Journal of Intensive Care Medicine 08/2011; 37(11):1800-8. · 5.17 Impact Factor
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ABSTRACT: The clinical indicator is a tool used to monitor the quality of health care. Its use in the Intensive Care Unit (ICU) is desirable for many reasons: the maintenance of minimum standards, the development of best practice and the delivery of cost-effective health care. The utility of clinical indicators in ICU is limited by the lack of universal, robust, transparent, evidence-based and risk-adjusted measures of quality, and the difficulties in defining "quality care" and "good outcome". Monitoring of adverse events, system descriptors, and resource indicators is valuable but they have a limited relationship to the quality of care. ICU mortality prediction models provide a global measure of quality and, despite their inherent deficiencies, remain one of the most robust and useful clinical indicators.
Anaesthesia and intensive care 07/2005; 33(3):303-10. · 1.28 Impact Factor
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ABSTRACT: Survival from acute coronary syndromes and major trauma has been shown to depend on timely access to definitive treatment. We sought to identify the significance of intensive care unit (ICU) admission delay (lead-time) on the outcome of critically-ill medical patients with other diagnoses.
From 1 January 1997 to 31 December 2003, a prospective cohort study was performed in critically-ill patients requiring mechanical ventilatory support (MV) and/or renal replacement therapy (RRT), admitted directly to the Northern Hospital ICU within 24 hours of arrival in the emergency department (ED). Patients were excluded if, a) they were admitted following surgery, major trauma or transfer from another hospital, or b) their duration of ICU stay was < 8 hours. Data collected included de-identified patient demographics, final diagnosis, APACHE II mortality risk (pm) and lead-time (i.e. difference between times of entrance to the ED and ICU.) The primary outcome measure was hospital discharge status.
Six hundred and nineteen consecutive ICU admissions from the ED met the inclusion criteria and required MV (n = 557) and/or RRT (n = 162.) Non-survivors were older (median age 73 vs. 54 yrs) and sicker (median pm 0.72 vs. 0.23) compared with survivors. Multivariate analysis using logistic regression identified lead-time as a significant predictor of mortality (RR = 1.06 per hour, 95% CI =1.01 - 1.10; p=0.015) in addition to age, diagnosis and illness severity.
ICU admission delay (lead-time) is associated with a greater mortality-risk in critically ill medical patients requiring MV and/or RRT.
Critical care and resuscitation: journal of the Australasian Academy of Critical Care Medicine 12/2004; 6(4):261-7. · 1.67 Impact Factor
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The Journal of practical nursing 07/1995; 45(2):28-35; quiz 36-7.
