Does a screening checklist for complex health and social care needs have potential clinical usefulness for predicting unplanned hospital readmissions in intensive care survivors: development and prospective cohort study

• Published in: BMJ open Vol. 12; no. 3; p. e056524
• Main Authors: Walsh, Timothy Simon, Pauley, Ellen, Donaghy, Eddie, Thompson, Joanne, Barclay, Lucy, Parker, Richard Anthony, Weir, Christopher, Marple, James
• Format: Journal Article
• Language: English
• Published: England British Medical Journal Publishing Group 23-03-2022; BMJ Publishing Group LTD; BMJ Publishing Group
• Series: Original research
• Subjects: Activities of Daily Living; Anxiety; Caregivers; Checklist; Cohort analysis; Critical Care; critical illness; Drug abuse; Emergency medical care; Health risks; Hospitalization; Hospitals; Humans; Illnesses; Intensive Care; Intensive Care Units; Intervention; Medical records; Medical screening; Mental health; Obstetrics; Patient Discharge; Patient Readmission; Patients; Polypharmacy; Prospective Studies; Quality of life; readmission; recovery; Recovery (Medical); Rehabilitation; Reproducibility of Results; screening; Social Support; Survivor; Survivors; transitions of care; triage; United Kingdom > UK; Scotland; transitions of care; screening; intensive care; critical illness; readmission; recovery; triage
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2021-056524

ObjectivesIntensive 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.DesignA 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.SettingICU, Royal Infirmary, Edinburgh, UK.ParticipantsICU survivors over a 12-month period (1 June 2018 and 31 May 2019).InterventionsNone.Outcome measureReadmission or death in the community within 3 months postindex hospital discharge.ResultsOf 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).ConclusionsEarly 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.