Novel Tool Could Predict Hospital Readmissions

Researchers recently created a novel tool that can potentially predict hospital readmission for patients who underwent surgery.

The tool, called a nomogram, accounts for 7 common variables to assess which patients are likely to be readmitted to the surgical intensive care unit (SICU) soon after discharge, according to a study presented at the 2016 Clinical Congress of the American College of Surgeons.

“A nomogram simplifies the process of calculating risk and could easily be used by a clinician in the SICU without the need for a complex equation,” said study presenting author, Luke A. Martin, MD.

The researchers said this tool is a very beneficial to patients and physicians, alike.

“If we can recognize that a patient’s condition is at risk of deteriorating before it happens, we may be able to prevent it,” Dr Martin said. “And preventing ICU readmission avoids transitions to and from the SICU and the general inpatient ward. Transitions of care are episodes when errors and adverse events often can occur.”

Limiting costs will also benefit the healthcare industry, since the US Centers for Medicare and Medicaid Services fine hospitals that have a significant amount of 30-day readmissions.

In the study, researchers examined medical records for SICU readmissions at a hospital between 2010 and 2015. Of the 3109 admissions, there were 141 readmissions within 72 hours from discharge. A majority (43%) were trauma patients, another 34% underwent general surgery, 14% had a vascular operation, and 9% received a transplant.

They analyzed 179 potential risk factors, including information such as patient demographics and data collected in the SICU to determine which factors that had the most significant contribution to readmission, according to the study.

There were 7 risk factors that researchers concluded had an effect on readmission:

• patient age
• respiratory rate
• atrial Fibrillation
• poor renal function
• amount of urea nitrogen in the blood
• blood glucose level
• levels of serum chloride

Once the risk factors were discovered, values were assigned to each, with higher values corresponding to higher risks. For example, an older patient would be assigned a higher value.

These points assigned to the factors were added together and presented on the nomogram. The lowest value was 40, meaning that the patient had minimal risk of readmission, and the highest values were 115 to 150 points, meaning that the patient had a 21 to 50% chance of readmission.

The nomogram was then tested using data from 577 patient records that were not included in the data used to create the tool.

“The risk prediction model has a moderately good ability to predict readmission to the surgical ICU and takes only about a minute to calculate for each patient,” Dr Martin said. “This nomogram allows for a quick and easy assessment of the surgical ICU patient’s readiness to leave the SICU.”

This tool could be used to prevent readmission by extending the patient’s initial stay, sending the patient to a unit for immediate care, or providing close monitoring of the patient after discharge from the SICU to a general inpatient stay.

The tool could also be implemented in a number of hospitals since a variety of surgical patients were included in the sample, the study concluded.