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Prevalence and risk factors associated within 48-hour unplanned paediatric intensive care unit readmissions: An
Martina K Barnwell1, Huaqiong Zhou2, Simon Erickson3
1School of Nursing and Midwifery, Curtin University, Bentley, WA, Australia; Paediatric Critical Care, Perth Children's Hospital, Nedlands, WA, Australia; Curtin School of Nursing, Curtin University, Perth, WA, Australia.
Insights
Unplanned readmissions to the paediatric intensive care unit (PICU) are linked to modifiable risk factors. Re-evaluating discharge readiness for high-risk patients can improve safety and reduce readmissions.
Area of Science:
- Pediatric Intensive Care
- Healthcare Quality Improvement
- Clinical Risk Management
Background:
- Unplanned paediatric intensive care unit (PICU) readmission is a critical indicator of care quality, associated with adverse patient outcomes and increased costs.
- Limited and inconsistent research exists on the specific risk factors contributing to unplanned PICU readmissions.
Purpose of the Study:
- To systematically review and synthesize the prevalence of unplanned within-48-hour PICU readmissions.
- To identify and consolidate associated risk factors for unplanned PICU readmissions.
Main Methods:
- An integrative review methodology was employed, adhering to a five-stage framework.
- Searched seven electronic databases from 2013 to June 2023 for relevant English-language studies with full-text access.
- Included studies were critically appraised for quality using Joanna Briggs Institute checklists.
Main Results:
- Ten studies met the inclusion criteria, reporting readmission rates ranging from 0.008% to 6.49%.
- Fifteen significant risk factors were identified, with twelve consistently reported: age, weight, chronic conditions, admission source, unplanned admission, PICU length of stay, positive pressure ventilation, discharge disposition, oxygen needs, respiratory rate, heart rate, and Glasgow Coma Score at discharge.
- Five key modifiable risk factors were highlighted: discharge disposition, oxygen requirement, abnormal respiratory rate, abnormal heart rate, and decreased Glasgow Coma Score at discharge.
Conclusions:
- Unplanned PICU readmissions are complex, influenced by various factors and a lack of standardized assessment.
- The identified modifiable risk factors suggest clinical instability and potentially premature discharge.
- Re-evaluation of discharge readiness for patients with modifiable risk factors is crucial, supported by enhanced ward care strategies like senior nursing allocation and appropriate nurse-to-patient ratios.
Background:
Unplanned paediatric intensive care unit (PICU) readmission is associated with increased morbidity/mortality, hospital length of stay, and health service cost and is recognised as a key performance indicator of quality-of-care delivery. However, research evidence on unplanned PICU readmission risk factors is limited, and results were inconsistent across studies.
Aim:
The aim of this experiment was to collate and synthesise unplanned within-48-h PICU readmission prevalence and associated risk factors.
Methods:
An integrative review was conducted, guided by a five-stage framework. Seven electronic databases were searched (2013-30th June 2023). Studies published in English with full-text accessibility and detailed methodologies were included. The quality of included studies was critically appraised using the Joanna Briggs Institute checklists. Prevalence and risk factors were extracted, synthesised, and presented narratively.
Results:
Ten studies met eligibility criteria and reported a varied readmission rate from 0.008% to 6.49%. Fifteen types of significant risk factors were extracted. Twelve consistently cited risk factors were age, weight, complex chronic conditions, admission source, unplanned admission, PICU length of stay, positive pressure ventilation, discharge disposition, oxygen requirements, respiratory rate, heart rate, and Glasgow Coma Score at discharge. Of the 12, five predictors were classified as modifiable factors, including discharge disposition, oxygen requirement, abnormal respiratory rate, abnormal heart rate, and decreased Glasgow Coma Score at discharge.
Conclusion:
This review acknowledges the complexity of confounding factors impacting unplanned PICU readmission and the lack of standardisation examining potential risk factors. The five modifiable factors are suggestive of clinical instability and premature PICU discharge. Patients with modifiable risk factors should have their readiness for discharge re-evaluated. Scaffolding support to manage patients at risk of readmission includes senior bedside nursing allocation, use of PICU outreach services, and 1:2 nurse-to-patient ratios in the ward setting, which are warranted to ensure patient safety.
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