Reduce Readmissions With Risk Stratification and Multidisciplinary Approach

Patients who are transferred from the ICU to intermediate care before they are ready risk readmission to the ICU, which can affect outcomes and healthcare costs.

“Current literature says that the average length of stay for a patient who has been readmitted in the ICU actually increases — sometimes doubles,” said Timothy H. Madeira, a dual clinical nurse specialist and nurse practitioner in the Division of Cardiac Surgery at Johns Hopkins Hospital in Baltimore. Madeira and colleagues Diane Law and Sharon Owens presented “ICU Readmissions: Knowing When Your Patient Is Ready for the Progressive Care Unit” and described their institution’s work to reducing ICU readmissions.

“We identified four risk factors for patients who were at highest risk for bounceback to the ICU: female gender, NYHA class III or IV heart failure status, if they had an urgent or emergent operative status when they went into the OR and if they had postoperative renal failure,” Madeira said.

Using a predictive model and risk scoring system, they stratify patients as low, moderate or high risk for ICU readmission and meet weekly with a multidisciplinary team to discuss the previous week’s readmissions.

“This has really helped the nursing collaboration between our ICU and our step-down unit and has opened a door to improved communication because everyone gets an equal voice at the table,” Madeira said. “This is always going to be an ongoing project, but we have already seen a reduction in our readmissions to the ICU and have seen better outcomes.”