title: Are readmissions to the intensive care unit a useful measure of hospital performance?
abstract: BACKGROUND
  Although patients readmitted to intensive care units (ICUs) typically have poor outcomes, ICU readmission rates have not been studied as a measure of hospital performance.
  
  
  OBJECTIVE
  To determine variation in ICU readmission rates across hospitals and associations of readmission rates with other ICU-based measures of hospital performance.
  
  
  METHODS
  Observational cohort study.
  
  
  METHODS
  One hundred three thousand nine hundred eighty four consecutive ICU patients who were admitted to twenty eight hospitals who were then transferred to a hospital ward in those 28 hospitals.
  
  
  METHODS
  Predicted risk of in-hospital death and ICU length of stay (LOS) were determined by a validated method based on age, ICU admission source, diagnosis, comorbidity, and physiologic abnormalities. Severity-adjusted mortality rates, LOS, and readmission rates were determined for each hospital.
  
  
  RESULTS
  One or more ICU readmissions occurred in 5.8% patients who were initially classified as postoperative and in 6.4% patients who were initially classified as nonoperative. In-hospital mortality rate was 24.7% in patients who were readmitted as compared with 4.0% in other patients (P < 0.001). After adjusting for predicted risk of death, the odds of death remained 7.5 times higher (OR 7.5, 95% CI, 6.8-8.3). Readmitted patients also had longer (P < 0.001) ICU LOS (5.2 vs. 3.7 days) and hospital LOS (29.3 vs. 11.7 days). Severity-adjusted readmission rates varied across hospitals from 4.2% to 7.6%. Readmission rates were not correlated with severity-adjusted hospital mortality, ICU LOS, or hospital LOS.
  
  
  CONCLUSIONS
  ICU patients who were subsequently readmitted have a higher risk of death and longer LOS after adjusting for severity of illness. However, readmission rates were not associated with severity-adjusted mortality or LOS. Those data indicate that ICU readmission may capture other aspects of hospital performance and may be complementary to these measures.
authors.affiliation: Division of Gastroenterology, University Hospitals of Cleveland, Case Western Reserve University School of Medicine, OH 44106, USA. gxc12@po.cwru.edu
authors.forename: G S
authors.initials: GS
authors.lastname: Cooper
authors.forename: C A
authors.initials: CA
authors.lastname: Sirio
authors.forename: A J
authors.initials: AJ
authors.lastname: Rotondi
authors.forename: L B
authors.initials: LB
authors.lastname: Shepardson
authors.forename: G E
authors.initials: GE
authors.lastname: Rosenthal
mesh_terms: D005260:Female; D006302:Health Services Research; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000592:standards* / Q000706:statistics & numerical data*; D007902:Length of Stay; D008297:Male; D016017:Odds Ratio; D009820:Ohio; D010359:Patient Readmission / Q000706:statistics & numerical data*; D019984:Quality Indicators, Health Care; D012306:Risk