Patients readmitted to ICUs* : a systematic review of risk factors and outcomes.
OBJECTIVE
To evaluate the causes, risk factors, and mortality rates associated with unexpected readmission to medical and surgical ICUs.


METHODS
MEDLINE citation review of primary articles focusing on ICU readmission or ICU outcomes from January 1966 to June 1999, and contact with authors of primary studies.


METHODS
Eight primary studies of ICU readmission and eight multi-institutional ICU outcome studies that reported ICU readmission rates were included.


METHODS
We abstracted data on the methodology and design of the primary studies, overall rates, causes, predictors, outcomes, and measures of quality of care associated with ICU readmission.


RESULTS
The average ICU readmission rate of 7% (range, 4 to 14%) has remained relatively unchanged in both North America and Europe. Respiratory and cardiac conditions were the most common (30 to 70%) precipitating cause of ICU readmission. Patients readmitted to ICUs had average hospital stays at least twice as long as nonreadmitted patients. Hospital death rates were 2- to 10-times higher for readmitted patients than for those who survived an ICU admission and were never readmitted. Predictors of ICU readmission have been neither well studied nor reproducible. Unstable vital signs, especially respiratory and heart rate abnormalities, and the presence of poor pulmonary function at time of ICU discharge appear to be the most consistent predictors of ICU readmission. There were no consistent data supporting the use of readmission rates as a measure of quality of care.


CONCLUSIONS
ICU readmission is associated with dramatically higher hospital mortality. Unstable vital signs at the time of ICU discharge are the most consistent predictor of ICU readmission. Further studies focusing on processes of ICU and hospital care are needed to determine if ICU readmission rates are a measure of quality of care.
Department of Anesthesiology and Critical Care, University of Michigan Medical Center, Ann Arbor 48109, USA. arosen@umich.edu
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Rosenberg
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Watts
D005060:Europe; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000592:standards / Q000706:statistics & numerical data; D007902:Length of Stay; D009656:North America; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011785:Quality Assurance, Health Care; D012307:Risk Factors