Association Between Nursing Workload and Intensive Care Unit Readmissions: A Prospective Cohort Study

AIM: The aim of this study was to assess the relationship between nursing workload at the time of intensive care unit discharge and the likelihood of intensive care unit readmission. DESIGN: This single-center prospective cohort study was conducted at a Belgian academic hospital and included all intensive care unit admissions from June 1, 2021 to May 31, 2022. METHODS: The Nursing Activities Score was documented by the nurse responsible for each patient during every shift. Adult patients (≥ 18 years) with intensive care unit stay exceeding 24 h during the study period were eligible for inclusion. Those discharged to another hospital, a nursing home, or their own home were excluded due to the inability to ensure follow-up. RESULTS: Among the 1293 eligible admissions recorded during the study period, 133 patients (10.3%) experienced readmission. Readmitted patients exhibited a higher prevalence of medical reasons for intensive care unit admission, significantly increased mortality rates, and longer hospital length of stay compared to non-readmitted patients. The average daily Nursing Activities Score did not differ significantly between the two groups. The Nursing Activities Score at intensive care unit discharge was notably higher in readmitted patients, and those with a score above the median at discharge demonstrated an increased risk of readmission within 30 days. In multivariable analysis, a high Nursing Activities Score at intensive care unit discharge was an independent predictor of readmission. CONCLUSIONS: An elevated nursing workload, as indicated by the Nursing Activities Score recorded at intensive care unit discharge, was significantly associated with a higher risk of readmission. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: The study examines the relationship between nursing workload at the time of ICU discharge and the likelihood of unplanned readmission. The results highlight the critical role of nursing workload assessment at ICU discharge in capturing the complexity of care requirements patients face at discharge. The results emphasise the importance of revising discharge planning processes, identifying nursing workload as a critical factor in unplanned readmissions. REPORTING METHOD: STROBE guidelines were used for this study. PATIENT OR PUBLIC CONTRIBUTION: Not applicable.