Abstract
BackgroundReadmission to intensive care units (ICU) is accompanied with longer ICU stay as well as higher ICU, in-hospital and 30-day mortality. Different scoring systems have been used in order to predict and reduce readmission rates.MethodsThe purpose of this study was to evaluate the Stability and Workload Index for Transfer (SWIFT) score as a predictor of readmission. Further, we wanted to study steps and measures taken at the ward prior to readmission.ResultsThis was a retrospective study conducted at the mixed surgical and medical ICU at Linköping University Hospital. One thousand sixty-seven patients >18 years were admitted to the ICU during 2 years and were included in the study. During the study period, 27 patients were readmitted to the ICU. Readmitted patients had a higher SWIFT score than the non-readmitted (16.1 ± 6.8 vs. 13.0 ± 7.5, p = 0.03) at discharge. The total ICU length of stay was longer (7.5 ± 7.5 vs. 2.9 ± 5.1, p = 0.004), and the 30-day mortality was higher (26 vs. 7 %, p < 0.001) for readmitted patients. Fifty-six percent of readmitted patients were assessed by the critical care outreach service (CCOS) at the ward prior to ICU readmission. A SWIFT score of 15 or more was associated with a significantly higher readmission rate (p = 0.03) as well as 30-day mortality (p < 0.001) compared to a score of ≤14.ConclusionsA SWIFT score of 15 or more is associated with higher readmission rate and 30-day mortality. The SWIFT score could therefore be used for risk prediction for readmission and mortality at ICU discharge.
Highlights
Readmission to intensive care units (ICU) is accompanied with longer ICU stay as well as higher ICU, in-hospital and 30-day mortality
Patients discharged to a ward without treatment strategies with a Stability and Workload Index for Transfer (SWIFT) ≥15 had a Discussion In this study, we found that patients readmitted to the ICU had a significantly higher SWIFT score as well as modified SWIFT (M-SWIFT) at ICU discharge than non-readmitted patients
In addition to a reduced partial pressure of oxygen in arterial blood (PaO2)/fraction of inspired oxygen (FiO2) ratio, we found that readmitted patients had a significantly higher rate of kidney failure, acute as well as chronic, than nonreadmitted patients
Summary
Readmission to intensive care units (ICU) is accompanied with longer ICU stay as well as higher ICU, in-hospital and 30-day mortality. The frequency of readmission within 72 h of intensive care unit (ICU) discharge is one of the most used and well-established measurements of quality in intensive care. Earlier studies have shown that readmitted patients have two to three times longer length of stay in the ICU than non-readmitted patients. Readmitted patients have two to ten times higher risk of death than patients who are not readmitted [1,2,3,4,5,6,7,8,9]. The readmission rate is 6–7 % [1, 2, 10].
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