中部某大學附設醫院內科加護病房非計畫性重返加護單位相關因素探討

Factors Related to Unplanned Readmission in a Medical Intensive Care Unit

游顯妹(Hsien-Mei Yu) ； 蔡曉鈴(Hsiao-Ling Tsai) ； 張淑華(Shu-Hua Chang) ； 廖憲華(Hsien-Hua Liao)

《中山醫學雜誌》 21卷2期 (2010/06) Pp. 161-177

https://doi.org/10.30096/CSMJ.201006.0004

摘要

Purpose: The purpose of this study was to explore the incidence, results, and factors related to unplanned readmission to the Medical Intensive Care Unit (MICU) of a university hospital in central Taiwan.
Method: In this case control study. We recruited patients discharged from the MICU between January 2006 and August 2008. A total of 40 patients who had the ”unplanned readmission within 48 hours of discharge” were assigned to the experiment group. Eighty patients who were not readmitted were assigned to the control group. The two groups were matched by age. A self-developed questionnaire was used to collect data from review medical record.
Results: About one percent (1.1%) of all discharged patients had unplanned readmissions within 48 hours. This group had a mortality rate of 75%. Patients with respiratory disorders had highest readmission rate (n=20, 50%). The incidence of readmission was more likely to occur during the evening shift (n=26, 65%). Risk analysis showed that the mortality rate of the unplanned readmitted patients was higher for those ≧65 years old (odds ratio: 3.0), with a positive blood culture (odds ratio: 2.67), who had received surgery during their first MICU hospitalization (odds ratio: 1.39), or those who were readmitted with a related diagnosis (odds ratio: 2.33). Patients who experienced unplanned readmission to the MICU had a significantly longer hospital stay and were more likely to receive surgical intervention than those who did not (P＜0.05). In addition, Patients who did not readmission to MICU have higher rate of blood sugar level than those who did (P＜0.05).
Conclusion: MICU patient who are admitted for respiratory disorders, who are more than 65 years old, have a positive blood culture, or who have received surgery during their MICU hospitalization, should be carefully evaluated before being transferred out of the MICU, and be carefully monitored after being transferred to a regular ward. Future study, a greater proportion of non-readmitted patient blood sugar levels, is able to investigate the correlation between these two factors. The occurrence of readmission to the MICU clearly prolongs the length of hospital stay, increases the patients and their families' economic burden and results in a waste of medical resources.

關鍵字

非計畫性重返 ； 內科加護病房

並列摘要

Purpose: The purpose of this study was to explore the incidence, results, and factors related to unplanned readmission to the Medical Intensive Care Unit (MICU) of a university hospital in central Taiwan.
Method: In this case control study. We recruited patients discharged from the MICU between January 2006 and August 2008. A total of 40 patients who had the ”unplanned readmission within 48 hours of discharge” were assigned to the experiment group. Eighty patients who were not readmitted were assigned to the control group. The two groups were matched by age. A self-developed questionnaire was used to collect data from review medical record.
Results: About one percent (1.1%) of all discharged patients had unplanned readmissions within 48 hours. This group had a mortality rate of 75%. Patients with respiratory disorders had highest readmission rate (n=20, 50%). The incidence of readmission was more likely to occur during the evening shift (n=26, 65%). Risk analysis showed that the mortality rate of the unplanned readmitted patients was higher for those ≧65 years old (odds ratio: 3.0), with a positive blood culture (odds ratio: 2.67), who had received surgery during their first MICU hospitalization (odds ratio: 1.39), or those who were readmitted with a related diagnosis (odds ratio: 2.33). Patients who experienced unplanned readmission to the MICU had a significantly longer hospital stay and were more likely to receive surgical intervention than those who did not (P＜0.05). In addition, Patients who did not readmission to MICU have higher rate of blood sugar level than those who did (P＜0.05).
Conclusion: MICU patient who are admitted for respiratory disorders, who are more than 65 years old, have a positive blood culture, or who have received surgery during their MICU hospitalization, should be carefully evaluated before being transferred out of the MICU, and be carefully monitored after being transferred to a regular ward. Future study, a greater proportion of non-readmitted patient blood sugar levels, is able to investigate the correlation between these two factors. The occurrence of readmission to the MICU clearly prolongs the length of hospital stay, increases the patients and their families' economic burden and results in a waste of medical resources.

並列關鍵字

Unplanned readmitted ； Medical Intensive Care Unit