Reducing readmissions to the intensive care unit

Objective: To determine factors that contributed to readmissions to the intensive care unit (ICU) from the general wards. Design: Prospective, descriptive, qualitative, and quantitative. Setting: The Royal Melbourne Hospital, which is a large, metropolitan, university-affiliated tertiary hospital with specialist and general wards. The ICU is a 14-bed medical and surgical adult unit. Patients: 572 patients admitted to ICU between July 1 and December 31, 1993. Results: There were 639 admissions, with 67 (10.5%) being readmissions. This study showed that 63% of all readmissions came from the general wards. The study identified three main factors that contributed to readmissions from the ward: progression of the patient’s illness, postoperative care requirements, and inadequate follow-up care on the general wards. Identifying inadequate continuity of care on the general wards as a cause of readmissions to the ICU led to the appointment of an ICU follow-up nurse to facilitate the transition from the ICU to the general ward. Conclusion: Preliminary results indicate that the appointment of the follow-up nurse has not only reduced the rate of readmissions to the ICU but also decreased the acuity levels of those readmitted. (Heart Lung® 1999;28:365-72)