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Korean J Crit Care Med > Volume 18(2); 2003 > Article
Korean Journal of Critical Care Medicine 2003;18(2): 74-79.
원저 : 중환자실에서 퇴실 시 중환자 전담 의사 결정이 재입실에 미치는 영향
한동우, 강원철, 반소영, 고신옥
연세대학교 의과대학 마취과학교실
The Effect of Discharge Decision-Making of the Intensivist on Readmission to the Intensive Care Unit
Dong Woo Han, One Chul Kang, So Young Ban, Shin Ok Koh
Department of Anesthesiology and Critical Care Medicine, Yonsei University College of Medicine, Seoul, Korea. sokoh@yumc.yonsei.ac.kr
BACKGROUND: Patients readmitted to intensive care unit (ICU) have significantly higher mortality. The role of intensivists to judge when to discharge from ICU may be important. We performed this study to assess the effect of intensivist's discharge decision-making on readmission to ICU. METHODS: Data were collected prospectively from patients admitted to ICUs (group 1). Another data were collected retrospectively from the patients' record (group 2). Discharge of the patients in group 1 were based on intensivist's discharge decision-making but not in group 2. We encouraged deep breathing and expectoration to patients of group 1 at risk of pulmonary complication during ICU stay and used a guideline for making discharge decisions. Readmission cause, length of ICU stay, Acute Physiology and Chronic Health Evaluation (APACHE) III score, and multiple organ dysfunction syndrome (MODS) score of readmitted patients were evaluated. RESULTS: Readmission rate of group 1 was lower than that of group 2 (p<0.05). The mortality of readmitted patients in each group was higher than that of non-readmitted patients (p<0.05). Respiratory disease was the major cause of readmission. In non-survivors of readmitted patients, APACHE III score on initial discharge and readmission, MODS score on initial admission, discharge and readmission were higher than those of survivors (p<0.05). CONCLUSIONS: Readmission rate was lower when intensivists participated in discharge decision- making. ICU readmission was associated with higher hospital mortality and longer ICU stay. MODS and APACHE III score at first discharge and readmission were significant prognostic factors of the outcome in readmitted patients.
Key Words: APACHE III score; Discharge decision-making; Intensive care unit; Intensivist; Multiple organ dysfunction syndrome; Readmission; Respiratory complication
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