title: Readmissions and deaths following ICU discharge: a challenge for intensive care.
abstract: OBJECTIVE
  Identify patients at risk for intensive care unit readmission, the reasons for and rates of readmission, and mortality after their stay in the intensive care unit; describe the sensitivity and specificity of the Stability and Workload Index for Transfer scale as a criterion for discharge from the intensive care unit.
  
  
  METHODS
  Adult, critical patients from intensive care units from two public hospitals in Porto Alegre, Brazil, comprised the sample. The patients' clinical and demographic characteristics were collected within 24 hours of admission. They were monitored until their final outcome on the intensive care unit (death or discharge) to apply the Stability and Workload Index for Transfer. The deaths during the first intensive care unit admission were disregarded, and we continued monitoring the other patients using the hospitals' electronic systems to identify the discharges, deaths, and readmissions.
  
  
  RESULTS
  Readmission rates were 13.7% in intensive care unit 1 (medical-surgical, ICU1) and 9.3% in intensive care unit 2 (trauma and neurosurgery, ICU2). The death rate following discharge was 12.5% from ICU1 and 4.2% from ICU2. There was a statistically significant difference in Stability and Workload Index for Transfer (p<0.05) regarding the ICU1 patients' outcome, which was not found in the ICU2 patients. In ICU1, 46.5% (N=20) of patients were readmitted very early (within 48 hours of discharge). Mortality was high among those readmitted: 69.7% in ICU1 and 48.5% in ICU2.
  
  
  CONCLUSIONS
  The Stability and Workload Index for Transfer scale showed greater efficacy in identifying patients more prone to readmission and death following discharge from a medical-surgical intensive care unit. The patients' intensive care unit readmission during the same hospitalization resulted in increased morbidity, mortality, length of stay, and total costs.
authors.affiliation: Integrated Health Residency - Intensive Care, Grupo Hospitalar Conceição - Porto Alegre, Rio Grande do Sul, Brazil. tatinhaga@yahoo.com.br
authors.forename: Tatiane Gomes de
authors.initials: TG
authors.lastname: Araujo
authors.forename: Marcelo de Mello
authors.initials: Mde M
authors.lastname: Rieder
authors.forename: Fernanda Machado
authors.initials: FM
authors.lastname: Kutchak
authors.forename: João Wilney
authors.initials: JW
authors.lastname: Franco Filho
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001938:Brazil; D015331:Cohort Studies; D003422:Critical Care; D005260:Female; D017721:Hospital Costs; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012680:Sensitivity and Specificity