A high intensive care unit (ICU) readmission rate does not necessarily point to poor patient care or result in negative outcomes, according to a single-centre study from Australia.

Researchers examined all ICU readmissions at the Epworth Richmond private hospital in Victoria, Australia for the 2015 calendar year. The findings of this retrospective cohort study were published as a poster at the recent SG-ANZICS Intensive Care Forum (SG-ANZICS 2017). [SG-ANZICS 2017, poster 56]

Out of the 1,906 ICU admissions in 2015, there were 106 readmissions (5.6 percent), 26 of which (19 percent) were planned readmissions due to elective surgery.

Fifty-one percent of unplanned readmissions (n=41) occurred within 72 hours of initial ICU discharge. Of these, 61 percent (n=25) required further organ support including invasive ventilation (19.5 percent), non-invasive ventilation (34.1 percent), vasoactive medications (31.7 percent), and renal replacement therapy (2.4 percent), while the remaining 39 percent required no support. One death occurred in the group of patients with unplanned readmission within 72 hours.

According to the researchers, there were no modifiable risk factors for readmission on initial ICU discharge among the unplanned readmissions, with stable physiological parameters on initial discharge.

“It appears that a high readmission does not always indicate deficiencies in patient care and result in poor patient outcomes,” said the researchers. “In 2015, a large majority of ICU readmissions were either greater than 72 hours postinitial ICU discharge, or were elective, preplanned postsurgical readmissions,” they said.

Previous studies have raised questions regarding the use of ICU readmission rates as quality measures. [Crit Care Med 2016;44:1704-1709; Crit Care Med 2013;41:24-33]

With this in mind, the researchers sought to identify if high ICU readmission rates pointed towards deficiencies in patient care.

Should ICU readmission rates be utilized as a quality indicator, readmission reporting requires further refinement, said the researchers. “This could include the reporting of additional data such as timing of readmission, mortality rates, further organ support received, and nature of the readmission,” they said.