Reducing readmissions to the intensive care unit

OBJECTIVE: To determine factors that contributed to readmissions to the int ensive care unit (ICU) from the general wards. DESIGN: Prospective, descriptive, qualitative, and quantitative. SETTING: The Royal Melbourne Hospital, which is a large, metropolitan, univ ersity-affiliated tertiary hospital with specialist and general wards. The ICU is a 14-bed medical and surgical adult unit. PATIENTS: 572 patients admitted to ICU between July 1 and December 31, 1993 . RESULTS: There were 639 admissions, with 67 (10.5%) being readmissions. Thi s study showed that 63% of all readmissions came from the general wards. Th e study identified three main factors that contributed to readmissions from the ward: progression of the patient's illness, postoperative care require ments, and inadequate follow-up care on the general wards. Identifying inad equate continuity of care on the general wards as a cause of readmissions t o the ICU led to the appointment of an ICU follow-up nurse to facilitate th e transition from the ICU to the general ward. CONCLUSION: Preliminary results indicate that the appointment of the follow -up nurse has not only reduced the rate of readmissions to the ICU but also decreased the acuity levels of those readmitted.