2002 OPEN FORUM Abstracts
RECIDIVISM TO THE ICU FOR RESPIRATORY SEQUELAE: A SOLUTION THAT WORKS.
Thomas J. Kallstrom, RRT, FAARC, Richard Treat, M.D., Beverly Maloney, RN, MSN, CNS, Deborah Elliot, RN, MSN, Fairview Hospital, Cleveland, Ohio
Background: Stabilized patients who no longer require the level of care provided in an ICU setting are transferred to our nursing divisions. There was a perception that a disproportionate number of patients returned to the ICU for respiratory related complications. Benchmarking data confirmed this. Our return rate was 7% compared to the benchmark of 3.8%. Of those that returned, 45% were due to respiratory complications. The remainder were for post?operative problems, GI bleeding, or blood pressure irregularities. Most returns occurred 24 - 48 hours post-discharge. Unless the patient was ordered to receive respiratory care, RT was not likely to be involved in the assessment or care of these patients.
Methods: A team (RTs, RNs, and physicians) was formed to identify causal factors of recidivism. An evaluation tool was developed to identify those patients at risk for return to the ICU. It was validated in a pilot program during which all patients were screened prior to transfer from the ICU. This high-risk evaluation tool considered inspiratory volume moved using an IS, PaCO2, oxygen saturation, and respiratory rate. A numerical value was assigned to levels within each category. If a patient had a score that was classified as high risk, they were placed on an oxygen and/or hyperinflation algorithm.These algorithms were structured to provide the patient with the appropriate therapy. RTs collaborated closely with unit-based RNs following the transfer of a patient from the ICU.
Results: The return rate to the unit during the study period (12 months) was 3.75% compared to 6.24% pre-intervention.
Conclusions: There are many variables that impact whether a patient will return to the ICU; some are within our control, and others are not. This demonstrated that a multidisciplinary team could address a problem and do so without adding staff members or increasing an already considerable patient load. We continue to monitor this and hope to report its progress in the future.