중환자실 조기 재입실 관련 위험요인

The Risk Factors Related to Early Readmission to the Intensive Care Unit.

  • 장진녕 (인제대학교부산백병원) ;
  • 이윤미 (인제대학교 간호학과, 건강과학연구소) ;
  • 박효진 (경남정보대학교 간호학과) ;
  • 이현주 (동명대학교 간호학과)
  • Jang, Jin Nyoung (Inje University Busan Hospital) ;
  • Lee, Yun Mi (Department of Nursing, Institute of Health Science, Inje University) ;
  • Park, Hyo Jin (Department of Nursing, Kyungnam College of Information & Technology) ;
  • Lee, Hyeon Ju (Department of Nursing, Tongmyong University)
  • 투고 : 2018.11.15
  • 심사 : 2019.01.31
  • 발행 : 2019.02.28

초록

Purpose : The purpose of this study was to identify status and characteristics of patients who have been readmitted to ICU, and to analyze risk factors associated with the readmission to ICU within 48hours. Method: Data were collected from patient's electronic medical reports from one hospital in B city. Participants were 2,937 patients aged 18 years old or older admitted to the ICU. Data were analyzed using odd ratios (ORs) from multivariate logistic regressions. Results: 2.2% of the 2,937 patients were early readmitted to ICU. Risk factors for early readmission to ICU were existence of respiratory disease, use of mechanical ventilator, and duration of hospitalization (longer). Conclusion: The assessment on the respiratory system of the patient who will be discharged from the ICU was identified as an important nursing activity. Therefore, the respiratory system management and education should be actively conducted. In addition, early ICU readmission may be prevented and decreased if a link was built to share the information on patient condition between the ICU and general wards.

키워드

참고문헌

  1. Boudesteijn, E., Arbous, S., & Van Den Berg, P. (2007). Predictors of intensive care unit readmission within 48 hours after discharge. Critical Care, 11(2), 475. https://doi.org/10.1186/cc5635
  2. Brown, S. E., Ratcliffe, S. J., Kahn, J. M., & Halpern, S. D. (2012). The epidemiology of intensive care unit readmissions in the United States. American Journal of Respiratory and Critical Care Medicine, 185 (9), 955-964. https://doi.org/10.1164/rccm.201109-1720OC
  3. Chan, K. S., Tan, C. K., Fang, C. S., Tsai, C. L., Hou, C. C., Cheng, K. C., & Lee, M. C. (2009). Readmission to the intensive care unit: An indicator that reflects the potential risks of morbidity and mortality of surgical patients in the intensive care unit. Surgery Today, 39 (4), 295-299. https://doi.org/10.1007/s00595-008-3876-6
  4. Cho, J. B. (2014). What intensive care unit readmission means. Allergy Asthma Respiratory Disease, 2(2), 83-84. https://doi.org/10.4168/aard.2014.2.2.83
  5. Desautels, T., Das, R., Calvert, J., Trivedi, M., Summers, C., Wales, D. J., & Ercole, A. (2017). Prediction of early unplanned intensive care unit readmission in a UK tertiary care hospital: A cross-sectional machine learning approach. British Medical Journal Open, 7 (9), e017199.
  6. Elliott, M. (2006). Readmission to intensive care: A review of the literature. Australian Critical Care, 19 (3), 96-98, 100-104. https://doi.org/10.1016/S1036-7314(06)80004-4
  7. Elliott, M., Crookes, P., Worrall-Carter, L., & Page, K. (2011). Readmission to intensive care: A qualitative analysis of nurses' perceptions and experiences. Heart & Lung, 40 (4), 299-309. https://doi.org/10.1016/j.hrtlng.2010.04.006
  8. Elliott, M., Worrall-Carter, L., & Page, K. (2014). Intensive care readmission: A contemporary review of the literature. Intensive and Critical Care Nursing, 30 (3), 121-37. https://doi.org/10.1016/j.iccn.2013.10.005
  9. Frost, S. A., Tam, V., Alexandrou, E., Hunt, L., Salamonson, Y., Davidson, P. M,. . . . Hillman, K. M. (2010). Readmission to intensive care: Development of a nomogram for individualising risk. Critical Care and Resuscitation, 12 (2), 83-89.
  10. Han, D. W., Koh, S. O., & Lee, M. W. (2003). Clinical features and risk factors of patients readmitted to ICU. Korean Journal of Anesthesiology, 44(1), 78-83. https://doi.org/10.4097/kjae.2003.44.1.78
  11. Han, D. W., Nam, S. B., Lee, W. K., Lee, J. S., Kim, C. S., & Shin, C. S. (2004). Clinical outcomes of patients readmitted to intensive care unit. Korean Journal of Anesthesiology, 47 (3), 385-388. https://doi.org/10.4097/kjae.2004.47.3.385
  12. Hospital Nurses Association. (1994). The study on estimation of nursing cost. Seoul: Nursing in Living.
  13. Hospital Nurses Association. (2005). Critical patient classification. Retrived November 23, 2017, from http://www.khna.or.kr/web/information/article_search.php
  14. Health Insurance Review & Assessment Service. (2016). Results of 2014 ICU Suitability Evaluation. Retrived December 14, 2018, from http://www.hira.or.kr/re/diag/getDiagEvlList.do?pgmid=HIRAA030004000100
  15. Health Insurance Review & Assessment Service. (2018). Results of 2017 ICU Suitability Evaluation. Retrived November 14, 2018, from http://www.hira.or.kr/re/diag/getDiagEvlList.do?pgmid=HIRAA030004000100
  16. Kang, Y. A. (2014). Risk factors and clinical outcomes associated with unplanned ICU readmission after cardiac surgery (Unpublished master's thesis). Ulsan University, Ulsan, Korea.
  17. Kim, N. M. (2008). An exploratory study on the ICU readmission and its related factors in adults. Health & Nursing, 20(1), 23-32.
  18. Kim, Y. J., & Kim, K. S. (2013). Risk factors of unplanned readmission to intensive care unit. Journal of Korean Clinical Nursing Research, 19(2), 265-274. https://doi.org/10.22650/JKCNR.2013.19.2.265
  19. Knaus, W. A., Draper, E. A., Wagner, D. P., & Zimmerman, J. E. (1985). APACHE II: A severity of disease classification system. Critical Care Medicine, 13 (10), 818-829. https://doi.org/10.1097/00003246-198510000-00009
  20. Lin, F., Chaboyer, W., Wallis, M., & Miller, A. (2013). Factors contributing to the process of intensive care patient discharge: An ethnographic study informed by activity theory. International Journal of Nursing Studies, 50 (8), 1054-1066. https://doi.org/10.1016/j.ijnurstu.2012.11.024
  21. Makris, N., Dulhunty, J. M., Paratz, J. D., Bandeshe, H., & Gowardman, J. R. (2010). Unplanned early readmission to the intensive care unit: A case-control study of patient, intensive care and ward-related factors. Anaesthesia and Intensive Care, 38 (4), 723-731. https://doi.org/10.1177/0310057X1003800338
  22. Metnitz, P. G., Fieux, F., Jordan, B., Lang, T., Moreno, R., & Le Gall, J. R. (2003). Critically ill patients readmitted to intensive care units-lessons to learn? Intensive Care Medicine, 29 (2), 241-248. https://doi.org/10.1007/s00134-002-1584-z
  23. Nishi, G. K., Suh, R. H., Wilson, M. T., Cunneen, S. A., Margulies, D. R., & Shabot, M. M. (2003). Analysis of causes and prevention of early readmission to surgical intensive care. The American Surgeon, 69 (10), 913-917.
  24. Rosenberg, A. L., & Watts, C. (2000). Patients readmitted to ICUs : A systematic review of risk factors and outcomes. Chest, 118 (2), 492-502. https://doi.org/10.1378/chest.118.2.492
  25. Rojas, J. C., Carey, K. A., Edelson, D. P., Venable, L. R., Howel, M. D., & Churpek, M. M. (2018). Predicting intensive care unit readmission with machine learning using electronic health record data. Annals of the American Thoracic Society, 15 (7), 846-853. https://doi.org/10.1513/AnnalsATS.201710-787OC
  26. Song, D. H., Lee, S. G., Kim, C. G., Choi, D. J., Lee, S. I., & Park, S. K. (2003). Unplanned readmission to intensive care unit during the same hospitalization at a teaching hospital. Journal of Korean Society of Quality Assurance in Health Care, 10(1), 28-41.
  27. Watts, R., Pierson, J., & Gardner, H. (2007). Co-ordination of the discharge planning process in critical care. Journal of Clinical Nursing, 16 (1), 194-202. https://doi.org/10.1111/j.1365-2702.2005.01439.x
  28. Woldhek, A. L., Rijkenberg, S., Bosman, R. J., & van der Voort, P. H. (2017). Readmission of ICU patients: A quality indicator? Journal of Critical Care, 38, 328-334. https://doi.org/10.1016/j.jcrc.2016.12.001
  29. Wu, C. J., & Coyer, F. (2007). Reconsidering the transfer of patients from the intensive care unit to the ward: A case study approach. Nursing & Health Sciences, 9 (1), 48-53. https://doi.org/10.1111/j.1442-2018.2007.00294.x
  30. Zimmerman, J. E. (2008). Intensive care unit readmission: The issue is safety not frequency. Critical Care Medicine, 36 (3), 984-985. https://doi.org/10.1097/CCM.0B013E318165FC15