13 Other Invasive Therapy Tick if Yes and comment Other advanced therapies e.g. ECMO, oscillation, MARS 14 Not for Resuscitation Order Tick if Yes Written documentation in history that patient is not for Resuscitation, CPR, etc 15 Not for Return to ICU Tick if Yes Written or verbal order that patient will not be readmitted to ICU in the event of deterioration 16 Not for cardiac arrest team Tick if Yes Written that patient should not have the cardiac arrest team called in the event of deterioration 17 Not for emergency (MET) Call Tick if Yes Written that patient should not have MET call in the event of deterioration where a MET service exists 18 Tracheostomy Tick if Yes Tracheostomy in place on discharge from ICU 19 Non-invasive ventilation Tick if Yes Ventilation via nasal or full face mask on discharge from ICU. Excludes CPAP for sleep apnoea, high flow nasal oxygen 20 Inotrope Infusion Tick if Yes Infusions of inotropes for augmentation of blood pressure or cardiac output on discharge from ICU 21 Ongoing Renal Replacement Tick if Yes On discharge from ICU, it is planned that the patient will continue with dialysis (HD, PD, HF etc) 22 TPN Tick if Yes On discharge, patient continues or will receive TPN 23 Altered conscious state Tick if Yes On discharge, any departure from normal conscious state (GCS=15). Includes confusional state 24 Glasgow Coma on discharge from ICU Number Total GCS around time of discharge. If patient has tracheostomy, estimate if they can talk normally for full verbal points 25 Written Medical Discharge Summary Tick if Yes On discharge, a written medical discharge summary is in the medical record 26 Written Nursing Discharge Summary Tick if Yes On discharge, a written nursing discharge summary is in the medical record 27 Medical Handover Documented Tick if Yes On discharge, written documentation of handover to medical on ward
text appropriate but unique for that patient. 3 ICU Readmission Date/Time Date/Time Date/Time of readmission to ICU. DDMMYY, HHMM 4 Most Recent ICU Discharge Date/Time Date/Time Date/Time of original admission to ICU DDMMYY, HHMM 5 Planned readmission to ICU Tick Planned readmission if patient was booked to back to ICU for example after semi-elective surgery 6 Readmission from Operating Theatre Tick Tick of patient readmitted from Operating Theatre Choose one of the following 7.1 Elective Correction of Original Problem/Disease Tick For example, patient admitted post arrest returns for elective CABG 7.2 New Problem Unrelated to First Admission to ICU Tick For example, patient admitted with pneumonia but returns post laparotomy for perforated duodenal 7.3 Same Problem as First Admission to ICU Tick For example, patient in ICU with respiratory failure readmitted with hypoxia or sputum retention Choose any of the following 8.1 Premature Discharge from Previous ICU Admission Tick In retrospect, was the patient’s last ICU discharge premature? 8.2 Issues Related to Care During the Previous ICU Admission Tick In retrospect, were there things done or omitted in ICU which contributed to the readmission 8.3 Issues Related to Care During the Intervening Period on the Ward Tick In retrospect, were there things done or omitted on the ward which contributed to readmission 8.3 Readmission Following Emergency (MET) call Tick Did the readmission follow a MET call 8.4 Readmission Following Cardiac Arrest Tick Did the readmission follow a cardiac arrest 8.5 In Your Opinion, Could the Readmission been Prevented Tick Could the ward staff or ICU have intervened earlier to prevent this readmission. Table E3. Primary diagnosis categories on admission to ICU (APACHE III, major groups) Medical Surgical Cardiovascular 664 (6.52%) Cardiovascular 2723 (26.74%)
Other respiratory disease 10.8% Operative Gastrointestinal 7.1% GI perforation 6.0% GI bleeding 8.2% GI obstruction 7.4% GI neoplasm 7.7% Cholecystitis 1.8% Liver transplant 6.7% Other GI disease 7.8% Fistula/abscess 4.0% GI vascular ischemia 8.7% Pancreatitis 14.3% Peritonitis 9.4% Other GI inflammatory disease 0.0% Operative Neurological 6.4% Intracerebral hemorrhage 8.3% Subdural/epidural hematoma 5.7% Subarachnoid hemorrhage 12.9% Laminectomy/spinal cord 6.3% Craniotomy for neoplasm 1.9% Other neurological disease 6.6% Operative Trauma 6.2% Head trauma +/- multi-trauma 8.6% Multiple trauma excluding head 4.7% Burns 12.5% Multitrauma +/- spinal cord 0.0% Isolated cervical cord injury 0.0% Operative Renal 5.0% Renal neoplasm 7.1% Other renal disease 3.4% Kidney transplant 0.0% Genitourinary surgery 6.7% Operative Gynecological 2.2% Hysterectomy 3.7% Pregnancy related 0.0% Other gynecological 5.0% Operative Musculoskeletal 5.3% Orthopedic surgery 5.5% Skin surgery 3.1% Cellulitis 6.1% PVD: peripheral vascular disease CABG: coronary artery bypass ENT: Ear nose and throat
Inotropes Altered conscious state 105 (1.1%) 1455 (15.1%) p=0.001 5 (1.0%) p=1.0 130 (26.5%) p<0.001 p=0.67 3 (3.3%) p=0.08 12 (13.2%) p=0.77 Other factors Discharge to general Treatment Limits Cardiac surgery Medical diagnosis 4731 (49.1%) 520 (5.4%) 1954 (20.3%) 4280 (44.4%) 228 (46.5%) p=0.27 18 (3.7%) p=0.10 57 (11.6%) p<0.001 250 (51.0%) p=0.004 39 (42.9%) p=0.25 1 (1.1%) p=0.10 10 (11.0%) p=0.03 41 (45.1%) p=0.92 APACHE III Risk of Death (median, IQR) 0.09 (0.03,0.24) 0.18 (0.06, 0.40) p<0.001 0.09 (0.04, 0.28) p=0.20 ICU Length Stay (days, median, IQR) 1.76 (0.94, 3.46) 2.67 (1.14, 6.12) p<0.001 2.15 (1.04, 3.73) p=0.17 Hospital Length Stay (days, median, IQR) 10.88 (6.81,19.22) 29.93 (17.42, 55.85) p<0.001 36.65 (24.52, 56.87) p<0.001 Hospital Mortality 410 (4.3%) 114 (23.3%) p<0.001 8 (8.8%) p=0.06 Nursing discharge Morning 5592 (58.1%) 257 (52.4%) 194 (39.6%) 55 (60.4%) 30 (33.0%)
Afternoon Night 3487 (36.2%) 550 (5.7%) 39 (8.0%) p=0.02 6 (6.6%) p=0.75 Summaries written Medical Summary Nursing Summary Medical Handover Nursing Handover 8487 (88.1%) 6509 (67.6%) 2637 (27.4%) 2509 (26.1%) 445 (90.8%) p=0.072 353 (72.0%) p=0.04 126 (25.7%) p=0.44 129 (26.3%) p=0.92 77 (84.6%) p=0.33 57 (62.6%) p=0.31 22 (24.2%) p=0.56 22 (24.2%) p=0.81 Time to (hrs, Median, IQR) First observations First medical review 0.52 (0.25,1.42) 12.0 (2.99, 18.89) 0.50 (0.25,1.25) p=0.81 6.26 (2.25,15.9) p<0.001 0.67 (0.25,2.0) p=0.28 10.53 (3.04,17.12) p=0.37 Post Discharge MET/RRT Cardiac Arrest 457 (4.8%) 50 (0.52%) 222 (45.3%) p<0.001 29 (5.9%) p<0.001 8 (8.8%) p=0.08 1 (1.1%) p=0.38 * Premature discharge and delayed discharge were assessed at the time of first ICU discharge. MET/RRT refer to medical emergency or rapid response calls Table E8. Diagnoses on first and second ICU admission in 581 readmitted patients. Op. refers to an operative
diagnosis. Numbers in brackets are the actual cases recorded. Categories with very small numbers (e.g. medical hematology, operative genito-urinary) are not list in the table. Medical Diagnoses Surgical Diagnoses Admission Readmission Admission Readmission Cardiovascular (n=50) Cardiovascular (18) Op Cardiovascular (17) Respiratory (12) Op Cardiovascular (n=100) Op.Cardiovascular (35) Respiratory (22) Cardiovascular (19) Respiratory (n=80) Respiratory (49) Cardiovascular (9) Sepsis (5) Op Respiratory (n=32) Respiratory (11) Op.Respiratory (9) Cardiovascular (3) Gastrointestinal (n=32) Gastrointestinal (13) Op Gastrointestinal (6) Respiratory (5) Op.Gastrointestinal (n=86) Op.Gastrointestinal (42) Sepsis (15) Respiratory (10) Cardiovascular (6) Neurological (n=34) Neurological (20) Respiratory (8) Op Neurological (2) Op.Neurological (n=27) Neurological (9) Op.Neurological (8) Respiratory (3) Trauma (n=32) Respiratory (8) Trauma (7) Op Trauma (5) Op.Trauma (n=16) Respiratory (4) Sepsis (4) Op.Trauma (4) Sepsis (n=39) Sepsis (11) Respiratory (8) Op Cardiovascular (6)