Abstract 321: Factors Associated with Readmission Within 48 Hours to a Cardiac Critical Care Unit
Introduction: Readmission to the cardiac Critical Care Unit (CCCU) is associated with increased morbidity and mortality and is increasingly used as a measure of quality of care. We have previously shown that introduction of a Medical Emergency Team (MET) following CCCU discharges did not affect rates of readmission within 48 hours in our institution and most readmissions were within 8 hours. The objectives of this study were to identify factors which increase the risk of readmission to CCCU within 48 hours of discharge and to identify the consequences of readmission.
Methods: A retrospective review was performed. We included discharges from a cardiac Critical Care Unit (CCCU) at a quaternary academic health science centre in the 25 months ending January 2009. We defined index admission as that preceding readmission, and abstracted demographic information, admission details and physiologic parameters preceding discharge from an electronic patient record. Data were represented as means and compared using t-test and linear regression.
Results: There were 1266 discharges, with 54 (4.3%) children readmitted within 48 hours. Children readmitted were of similar age (2.67 v 2.95 yr, p=0.99), and had not been admitted more frequently in the previous 2 years (0.81 v 0.52 admissions, p=0.21). Length of index admission was not significantly different (160 v 138 hr, p=0.84), however discharge oxygen saturation was lower (90 v 93%, p=0.03) and Bedside PEWS score was higher (4.5 v 3.2, p=0.004) for those children readmitted within 48 hours. Discharge PELOD scores were similar (p=0.63). The PIM2 score at readmission was not significantly different (-4.12 v -4.31, p=0.11) and there was a trend suggesting greater length of CCCU stay (257 v 137 hr, p=0.05) for readmission. Five children (9%) who were readmitted died.
Conclusions: The rate of readmissions within 48 hrs over this period was higher than previously reported for our institution (4.3% v 2.4%). Factors associated with increased risk of readmission were lower discharge oxygen saturation and a higher composite physiological score (Bedside PEWS). Children had not spent longer in the unit. Children readmitted had a slightly longer stay during their readmission, and 9% of these children subsequently died.
- © 2012 by American Heart Association, Inc.