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Evaluation of Hospital-wide Readmission Risk Calculator to Predict 30-Day Readmission in Neurocritical Care Patients

Peacock, Sarah; Siegel, Jason; Harmer, Emily; Alejos, David; Freeman, W. David

Journal of Neuroscience Nursing: February 2019 - Volume 51 - Issue 1 - p 16–19
doi: 10.1097/JNN.0000000000000410
Article

ABSTRACT Background and Purpose: Thirty-day hospital readmissions have been shown to be a measure of quality and result in higher mortality and increased costs. Readmissions are a target for hospitals and payers; thus, several centers have developed predictive readmission scores to identify high-risk patients. The purpose of this study was to evaluate the current hospital-wide readmission risk calculator and the ability of this tool to predict 30-day readmissions in the neurocritical care population. Methods: A retrospective chart review was performed that included 340 consecutive patients admitted to our neuroscience critical care unit. Data including readmission scores, reason for admission, length of stay, and whether they were readmitted were recorded. Results: After removing patients without readmission scores or who died at the end of the original admission, the records of N = 279 patients were analyzed. Patients were more likely to be readmitted if they were initially emergently hospitalized or if there was a history of malignancy. Readmitted patients had a longer original hospital length of stay. Furthermore, 65.8% of the patients who were given a “low risk” for readmission were readmitted within 30 days. Conclusions: This small set of data in a specific patient population found that the current risk prediction score was inaccurate in predicting readmission in the neuroscience intensive care unit population. Further evaluation is needed of a larger patient population to generalize these results for all neuroscience intensive care unit patients. To design an accurate readmission risk tool, centers should create unique readmission scores based on less heterogeneous patient populations.

Jason Siegel, MD, Departments of Critical Care and Neurology, Mayo Clinic, Jacksonville, FL.

Emily Harmer, ARNP, Department of Critical Care, Mayo Clinic, Jacksonville, FL.

David Alejos, MD, Department of Internal Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, New York, NY.

W. David Freeman, MD, Departments of Critical Care, Neurology, and Neurosurgery, Mayo Clinic, Jacksonville, FL.

Questions or comments about this article may be directed to Sarah Peacock, MSN ACNP-BC, at peacock.sarah@mayo.edu. She is an Acute Care Nurse Practitioner, Department of Critical Care Medicine, Mayo Clinic, Jacksonville, FL.

Author Contributions: All authors contributed to the conception, design, image acquisition, and writing of the manuscript. They all had final approval of the submitted manuscript.

The authors declare no conflicts of interest.

© 2019 American Association of Neuroscience Nurses