Intensive care unit readmission prevention checklist: is it worth the effort?
OBJECTIVE
Checklists have been adopted by various institutions to improve patient outcomes. In particular, readmission prevention checklists may be of potential value to improve patient care and reduce medical costs. As a result, a prior quality improvement study was conducted to create an intensive care unit readmission prevention checklist. The previous pilot demonstrated zero readmissions when the readmission prevention checklist was utilized but yielded low compliance (30%). Thus, a subsequent quality initiative was undertaken to refine the readmission prevention checklist with the primary aim of improved compliance while maintaining a reduced readmission rate that was observed with the original quality improvement study.


METHODS
A single-centre, cross-sectional study for assessing baseline data and a prospective observational study to assess the effectiveness of a refined readmission prevention checklist tool in a 20-bed tertiary medical-surgical intensive care unit at an academic medical centre in Rochester, MN was conducted. Medical patients admitted through the emergency department, upon direct transfer from outside facility, and post-operative surgical patients at our institution were included. A refined readmission prevention checklist tool was administered during an 8-week pilot period for medical and post-operative surgical patients.


RESULTS
The refined readmission prevention checklist resulted in an even lower compliance (10.5%) from the initial phase likely resulting from utilization of a paper readmission prevention checklist in an electronic medical environment. Moreover, the refined readmission prevention checklist demonstrated a 22% unplanned readmission rate for patients in which the tool was utilized.


CONCLUSIONS
In conclusion, the findings of the current quality improvement study may serve to rethink the process of health care delivery that applies paper tools in an electronic medical environment.
Department of Anesthesiology - Critical Care Medicine Division, Mayo Clinic, Rochester, MN, USA.
Nathan J
NJ
Smischney
Kelly A
KA
Cawcutt
John C
JC
O'Horo
Ronaldo A
RA
Sevilla Berrios
Francis X
FX
Whalen
D000046:Academic Medical Centers; D057189:Checklist / Q000592:standards*; D003430:Cross-Sectional Studies; D006801:Humans; D007362:Intensive Care Units; D008910:Minnesota; D010359:Patient Readmission; D010865:Pilot Projects; D011446:Prospective Studies; D011785:Quality Assurance, Health Care; D011795:Surveys and Questionnaires
dismissal checklist; electronic; intensive care unit; paper; quality improvement; refined; unplanned readmission