Evaluation of Readmitted Patients After Intensive Care Unit Discharge (Retrospective Study)

Objective: Nearly %10 of the discharged patients are readmitted to intensive care unit (ICU) at the same hospital stay. Reduction of readmission rates could be used as a hospital performance indicator. Our aim is to analyse the reasons and results of readmissions of patients who were discharged to a general ward from ICU in a two-year period. Method: Readmissions of the patients who had been treated in our ICU between the dates of 01.01.2015-31.12.2016 were analysed retrospectively. Demographic characteristics of patients, readmission rates, initial admission indications and comorbidities, distribution of readmission indications, timing of readmission after discharge, distribution of patients in terms of mechanical ventilation need, discharge time of readmitted patients at initial admission to ICU after weaning, readmission mortality rates, Glasgow Coma Scale (GCS), APACHE-II and SOFA scores of patients at initial admission and readmission were analysed and compared. Results: 59 patients (3.55%) are readmitted to ICU after discharge at the same hospital stay. When examining the departments where the readmitted patients came from, it is seen that 19 patients (32.2%) were readmitted to ICU from department of general surgery. 22 of readmissions (37.29%) occurred within first 48 hours after discharge. The most common reasons of readmissions are for postoperative monitoring after revisional surgery (44.07%) and acute respiratory failure (40.68%). Conclusion: The patients who are discharged from ICU are at a high risk of being readmitted to ICU (35). Readmission to ICU is associated with higher mortality risk than the initial admission. The first step of reducing the rates of readmission to ICU process is to anticipate the patients who would be readmitted to ICU priorly and improve service wards healthcare quality.

Amaç: Taburcu edilen hastaların yaklaşık %10’ u yatış süresi içerisinde yeniden yoğun bakım ünitesine (YBÜ) gitmektedir. YBÜ’ye yeniden yatış oranlarındaki azalma, hastane performansında bir kalite göstergesidir. Bu çalışmadaki amacımız, YBÜ’den hastane içine, iki yıllık süre içerisinde taburcu edilen hastaların yeniden yatışlarının nedenlerini ve sonuçlarını analiz etmektir. Yöntem: 01.01.2015-31.12.2016 tarihleri arasında hastanemiz YBÜ’de tedavi edilen hastaların tekrar yatışları geriye dönük olarak incelendi. Hastaların demografik özellikleri, tekrar yatış oranları, hastaların ilk yatış endikasyonları ve yandaş hastalıkları, tekrar yatışların endikasyonlarına göre dağılımı, tekrar yatışın taburculuk sonrası ne zaman gerçekleştiği, mekanik ventilasyon ihtiyacına göre hastaların dağılımı, tekrar yatışı olan hastaların birinci kabullerinde weaning sonrası taburcu olma zamanı, tekrar yatışlardaki mortalite oranları, hastaların YBÜ’ye ilk ve tekrar yatışındaki Glasgow Koma Skalası (GCS), APACHE-II ve SOFA skorları incelenerek kıyaslandı. Bulgular: YBÜ’den taburcu edilen ve hastaneden taburcu olmadan tekrar yatışı yapılan hasta sayısı 59 olarak bulundu (%3,55). Hastaların tekrar geldikleri bölümler incelendiğinde en fazla 19 (%32,2) hasta Genel Cerrahi Kliniği’ndendi. Tekrar kabul edilen hastaların 22’si (%37,29) taburcu edildikten sonraki ilk 48 saat içinde gerçekleşti. Tekrar kabul edilen hastaların en sık nedenleri; revizyon cerrahisi sonrasında postoperatif monitorizasyon (%44,07) ve akut solunum yetersizliği (%40,68) olarak belirlendi. Sonuç: YBÜ’den taburcu edilen hastalar, tekrar YBÜ’ye kabul için yüksek risk altındadırlar. Yoğun bakım ünitesine geri kabul, ilk kabulden çok daha yüksek mortalite oranları ile ilişkilidir. YBÜ’ye geri kabul oranlarını azaltmadaki önemli adım, önceden hastaları tanımak, tanımlamak ve servis bakım düzeylerini yükseltmektir.

Kaynakça

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