Key result
Complex needs checklist identifies ICU survivors at ~106% greater risk of 3-month readmission or death.
Why the study?
Intensive care survivors have high unplanned hospital readmission rates, but the optimal approach to triage patients for interventions is uncertain.
Does a screening checklist for complex health and social care needs predict unplanned hospital readmissions or death in ICU survivors?
Cohort (n=1,174)
No
Does a screening checklist for complex health and social care needs predict unplanned hospital readmissions or death in ICU survivors?
Effect estimate: RR 2.06 (95% CI 1.69 to 2.50)
Absolute Event Rate: 45% vs 22%
A screening checklist for complex health and social care needs at ICU discharge shows potential clinical usefulness for predicting 3-month readmission or death, with a relative risk of 2.06 for those with CHSCNs.
May aid risk stratification of ICU survivors; leaves open whether checklist-guided interventions reduce readmissions.
OBJECTIVES: Intensive care (ICU) survivors are at high risk of long-term physical and psychosocial problems. Unplanned hospital readmission rates are high, but the best way to triage patients for interventions is uncertain. We aimed to develop and evaluate a screening checklist to help predict subsequent readmissions or deaths. DESIGN: A checklist for complex health and social care needs (CHSCNs) was developed based on previous research, comprising six items: multimorbidity; polypharmacy; frequent previous hospitalisations; mental health issues; fragile social circumstances and impaired activities of daily living. Patients were considered to have CHSCNs if two or more were present. We prospectively screened all ICU discharges for CHSCNs for 12 months. SETTING: ICU, Royal Infirmary, Edinburgh, UK. PARTICIPANTS: ICU survivors over a 12-month period (1 June 2018 and 31 May 2019). INTERVENTIONS: None. OUTCOME MEASURE: Readmission or death in the community within 3 months postindex hospital discharge. RESULTS: Of 1174 ICU survivors, 937 were discharged alive from the hospital. Of these 253 (27%) were classified as having CHSCNs. In total 28% (266/937) patients were readmitted (N=238) or died (N=28) within 3 months. Among CHSCNs patients 45% (n=115) patients were readmitted (N=105) or died (N=10). Patients without CHSCNs had a 22% readmission (N=133) or death (N=18) rate. The checklist had: sensitivity 43% (95% CI 37% to 49%), specificity 79% (95% CI 76% to 82%), positive predictive value 45% (95% CI 41% to 51%), and negative predictive value 78% (95% CI 76% to 80%). Relative risk of readmission/death for patients with CHSCNs was 2.06 (95% CI 1.69 to 2.50), indicating a pretest to post-test probability change of 28%-45%. The checklist demonstrated high inter-rater reliability (percentage agreement ≥87% for all domains; overall kappa, 0.84). CONCLUSIONS: Early evaluation of a screening checklist for CHSCNs at ICU discharge suggests potential clinical usefulness, but this requires further evaluation as part of a care pathway.
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Walsh et al. (2022) conducted a cohort in Intensive care (ICU) survivors (n=1,174). Screening checklist for complex health and social care needs (CHSCNs) vs. Patients without CHSCNs was evaluated on Readmission or death in the community within 3 months postindex hospital discharge (RR 2.06, 95% CI 1.69 to 2.50). A screening checklist for complex health and social care needs identified ICU survivors at higher risk of 3-month readmission or death (45% vs 22%; RR 2.06; 95% CI 1.69 to 2.50).
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