Abstract
AbstractIntroductionIntensive care unit (ICU) readmission is associated with increased mortality, hospital and ICU length of stay (LOS), and healthcare cost. Scoring systems that use physiologic markers to predict readmission have been used with varying degrees of success and literature is lacking on which medication classes might contribute to ICU readmission.ObjectivesThe primary objective of this study was to identify medication classes associated with preventable ICU readmissions.MethodsThis was a retrospective, single‐center, observational, and cross‐sectional study of adult patients readmitted to the ICU within 72 h of ICU discharge between June 2015 and December 2016. Patients were excluded if they had multiple ICU readmissions. Readmissions were classified as non‐medication related (NMIR), non‐preventable medication related (NPMIR), or potentially preventable medication related (PPMIR) relative to ICU readmission diagnosis. Clinical outcomes including hospital LOS, ICU LOS, ICU LOS for readmission period, overall mortality, or presence of a rounding ward clinical pharmacist were evaluated, as was the estimated cost of readmissions.ResultsA total of 173 patients were included. Seventy‐six readmissions were determined to be medication‐related (44%) with 43 (57%) of those deemed preventable. The medication classes identified in PPMIRs were diuretics (32.5%), anti‐infectives (14%), opioids (11.6%), benzodiazepines (11.6%), electrolytes (7%), and antiarrhythmics (7%). No difference was observed for median hospital LOS, ICU LOS, ICU LOS for readmission period or overall mortality between those patients with a NMIR, NPMIR and those with a PPMIR. Total avoidable ICU LOS was 240.8 days based on median LOS.ConclusionsDiuretics, benzodiazepines, opioids, antiarrhythmics, and anti‐infectives were the most frequently identified medication classes associated with PPMIRs. Further study is needed to identify the impact of screening for high‐risk medication classes identified in this investigation and greater pharmacist involvement post ICU discharge in reducing ICU readmissions.
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