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Readmission to the ICU may be considered a benchmark quality indicator on an ICU. Previous studies have assessed the impact of out of hours discharge from the ICU and subsequent outcome [1,2]. We hypothesized that patients who were discharged from the ICU after hours were at higher risk of readmission to the ICU than patients discharged during daylight hours.
The database of a 15-bed medico-surgical ICU of a teaching hospital was retrospectively interrogated from the period 1 October 2007 to 31 July 2009. Patients who died whilst on the ICU were excluded from the study. Demographic details were collected as well as the date and time of discharge from the ICU. Readmissions to the ICU were defined as readmissions if they occurred during the same hospital admission episode. Out of hours discharges were defined as discharges occurring between the hours of 20:00 and 09:00. Logistic regression analysis was used to assess the relationship between timing of discharge from the ICU and risk of readmission.
The database contained 1,257 patients during the study period, of whom 207 died whilst on the ICU. A total of 1,050 patients were therefore included in the study. Two hundred and forty-nine patients (24%) were discharged between 20:00 and 09:00. Ninety-five patients (9%) were discharged and subsequently readmitted to the ICU during the same hospital admission episode. Compared with patients discharged between the hours of 09:00 and 20:00, patients discharged between the hours of 20:00 and 09:00 were 2.74 (95% CI 1.7 to 4.3) times more likely to be readmitted to the ICU during the same admission episode, P < 0.001. This relationship remained true even after adjusting for potential confounders age, gender. OR 2.75 (95% CI 1.7 to 4.3).
Compared with patients discharged during the day, patients discharged during the night are at a significantly increased risk of readmission to the ICU. Timing of discharge from ICU may therefore be used as a quality indicator in benchmarking quality of care on an ICU.