Analysis of readmission rates to the intensive care unit after implementation of a rapid response team in a University Hospital / El análisis de las tasas de reingreso en la unidad de cuidados intensivos después de la puesta en práctica de un equipo de respuesta rápida en un hospital universitario

Objectives: To compare readmission rates to the intensive care unit (ICU) before and after the implementation of a rapid response team (RRT), and to identify risk factors for readmission. Design: A quasi-experimental before-after study was carried out. Setting: A University Hospital. Patients: All patients discharged from the ICU from January to December 2008 (control group) and from January 2010 to December 2012 (intervention group). Intervention: Implementation of an RRT. Main variables of interest: The data included demographic parameters, diagnoses upon admission, ICU readmission, APACHE II, SOFA, and TISS 28 scores, and routine daily assessment by an RRT of patients discharged from the ICU. Results: During the study interval, 380 patients were analyzed in the period prior to the implementation of the RRT and 1361 after implementation. There was a tendency toward decreased readmission rates one year after RRT implementation. The APACHE II score and SOFA score at ICU discharge were independent factors associated to readmission, as well as clinical referral to the ICU. Conclusions: The RRT intervention resulted in a sustained decrease in readmission rates one year after implementation of this service. The use of a specialized team in health institutions can be recommended for ICU survivors (AU)

Objetivos: Comparar las tasas de reingreso en la UCI antes y después de la implementación de un equipo de respuesta rápida (RRT) e identificar los factores de riesgo para la readmisión. Diseño: Estudio cuasi experimental antes y después. Lugar: Hospital universitario. Pacientes: Todos los pacientes que fueron dados de alta de la UCI de enero a diciembre de 2008 (grupo control) y de enero 2010 a diciembre 2012 (grupo intervención). Intervención: Implementación de un RRT. Principales variables de interés: Los datos incluidos demográfica, los diagnósticos de ingreso, readmisión UCI, APACHE II, SOFA y TISS 28 puntuación y de evaluación de los pacientes dados de alta de la UCI por un TSR. Resultados: Durante el período de estudio, 380 pacientes fueron analizados en el período anterior a la implementación de la RRT y 1,361 después de la implementación. Hubo una tendencia a disminuir las tasas de reingreso después de un año de la implementación de un RRT. APACHE II y SOFA de alta de la UCI fueron factores independientes asociados a la readmisión, así como lo tipo de paciente médico. Conclusiones: La intervención del RRT resultó en una reducción sostenida de las tasas de reingreso un año después de la implementación de este servicio. El uso de un equipo especializado en instituciones de salud puede ser recomendado para los pacientes supervivientes de la UCI (AU)

Analysis of readmission rates to the intensive care unit after implementation of a rapid response team in a University Hospital.

OBJECTIVES: To compare readmission rates to the intensive care unit (ICU) before and after the implementation of a rapid response team (RRT), and to identify risk factors for readmission. DESIGN: A quasi-experimental before-after study was carried out. SETTING: A University Hospital. PATIENTS: All patients discharged from the ICU from January to December 2008 (control group) and from January 2010 to December 2012 (intervention group). INTERVENTION: Implementation of an RRT. MAIN VARIABLES OF INTEREST: The data included demographic parameters, diagnoses upon admission, ICU readmission, APACHE II, SOFA, and TISS 28 scores, and routine daily assessment by an RRT of patients discharged from the ICU. RESULTS: During the study interval, 380 patients were analyzed in the period prior to the implementation of the RRT and 1361 after implementation. There was a tendency toward decreased readmission rates one year after RRT implementation. The APACHE II score and SOFA score at ICU discharge were independent factors associated to readmission, as well as clinical referral to the ICU. CONCLUSIONS: The RRT intervention resulted in a sustained decrease in readmission rates one year after implementation of this service. The use of a specialized team in health institutions can be recommended for ICU survivors.

Acute respiratory distress syndrome in burn patients: incidence and risk factor analysis.

After a burn lesion, Acute Respiratory Distress Syndrome (ARDS) may occur via direct lung injury due to inhaled smoke and fumes or mediated by the inflammatory response associated with the burn or its infectious complications. The aim of the present study is to assess the epidemiologic profile of ARDS in adult burn patients admitted to intensive care in a burn unit at a university hospital. A prospective cohort study was performed from January to December 2012. Demographic and diagnostic data, prognostic scores, etiology and data on the extent and depth of burns were collected. Data related to risk factors for ARDS and death were also recorded. A total of 85 patients were included in the study. Patients were aged 41.7 (SD = 15.7) years old; 71.8% were male and the mean total body surface area burned was 28.3% (SD = 19.1%); 35.3% presented inhalation injuries. Invasive ventilatory support was required in 44 ICU inpatients (51.8%). ARDS was diagnosed in 38.6% of patients under invasive mechanical ventilation. In multivariate analysis, the presence of inhalation injuries was a risk factor for ARDS (OR = 9.75; CI 95% 2.79 - 33.95; P < 0.001). ARDS is a common complication in burn patients admitted to specialized intensive care units. Inhalation injuries were an independent risk factor for ARDS. Mortality rate observed in the study patients was high and associated with ARDS diagnosis.

Après une brûlure, un SDRA peut survenir soit en raison d'une atteinte pulmonaire directe (inhalation de fumées) soit en raison de la réaction inflammatoire due à la brûlure ou à une complication infectieuse. Le but de ce travail est d'évaluer l'épidémiologie des SDRA survenus chez des adultes brûlés hospitalisés dans l'unité de réanimation dédiée d'un CHU durant l'année 2012. Les données démographiques, celles concernant la brûlure (cause, étendue, profondeur, scores pronostics) et les facteurs de risque de SDRA ont été relevés. Quatre vingt cinq patients ont été inclus. Les patients étaient âgés de 41,7+/-15,7 ans, 71,8% d'entre eux étaient des hommes, ils étaient brûlés sur 28,3+/-19,1% de la SCT, 35,3% d'entre eux avaient des lésions d'inhalation. Quarante quatre patients (51,8%) ont eu besoin de ventilation mécanique. Un SDRA a été diagnostiqué chez 38,6% des patients ventilés. En analyse multivariée, les lésions d'inhalation sont un facteur de risque de SDRA (OR 9,75 ; IC95 2,79-33,95 ; p<0,001). Le SDRA est une complication fréquente chez les brûlés admis en unité de réanimation spécialisée. Les lésions d'inhalation sont un facteur de risque indépendant de SDRA. La mortalité de la cohorte était élevée, et associée au diagnostic de SDRA.