Readmission of patients to the surgical intensive care unit: patient profiles and possibilities for prevention.

Because experience is lacking regarding the profile of patients readmitted to a surgical ICU (SICU), we retrospectively reviewed total admissions, readmissions, patient profiles, and characteristics of illness requiring readmission to a multidisciplinary SICU. During a 1-yr period, the 721 recorded admissions included 68 readmissions for 57 patients (9.4% of the total). Eight patients had multiple readmissions. Seventy-five percent of the original admissions in these 57 patients occurred postoperatively, 9% were due to trauma, and 16% were caused by nonsurgical illness. Mortality for readmitted patients was 26%. Although 53 (78%) discharges were deemed appropriate, 62% of the patients manifested one or more of a retrospectively selected group of warning signs which might have alerted the responsible physician to alter the treatment plan. In half of these patients the reason for readmission was related to the warning sign. Readmission was related to the original disease in 65% of the incidents, while a new patient problem initiated readmission in 38%. The most common new problems were cardiopulmonary insufficiency and infection. All but one patient readmitted with pulmonary problems displayed retrospective evidence of clear warning signs before the original discharge. Recognition of SICU readmission patterns will allow more precise discharge planning: to delay discharge, to effect a lateral transfer, or to initiate a stepdown unit which may be able to help prevent costly and potentially lethal patient outcomes.