Patients readmitted to the intensive care unit: can they be prevented?

Readmission to the surgical intensive care unit of a tertiary care hospital has traditionally been tracked as a quality indicator and many studies have suggested various figures as to the acceptable rate of such. ICU beds being a precious resource readmitting a patient could imply hasty discharge or inadequate care. Patients readmitted generally have a higher mortality and length of stay due to the worsening of their illness. The definition of 'ICU readmission' varies from either in the first 24 hours, to over the next 2 days or even whether the patient comes back during the entire period of admission. The association between increasing severity of illness and the risk of readmission to ICU has not been systematically summarized and one can speculate as to the various predictive signs of possible readmission. We looked at our data over the past 5 months of all adult surgical ICU patients who were readmitted during the same admission after ICU discharge. Fourteen patients were readmitted with the monthly rate varying from 3-11% per month. The age ranged from 33 to 90 years and the gender was mostly male. The patients' initial admission diagnosis varied as they belonged to General surgery, ENT, Neurosurgery and Orthopedic disciplines and the time from initial discharge to readmission ranged from 40 to 4 days. The majority of the readmission causes were respiratory and these included desaturation, PE, pneumonia and mucus plugging. Other causes included hypotension, sepsis, dysrhythmias, recurrent drop in GCS and GI re-bleed. When compared to the first admission most patients had a longer length of stay during the readmission. The outcomes were mostly good with only one patient expiring after readmission.