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One in four intensive care patients are readmitted to hospital

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A quarter of intensive care patients are readmitted to hospital shortly after returning home, of which some are avoidable, according to a UK study.

Researchers said high levels of carer stress, difficulty understanding health and social care packages and psychological trauma all contributed to high rates of return.

“This is a fascinating chance to learn from patients”

Tim Walsh

They said pinpointing the reasons for unplanned readmissions was key to developing care packages that supported patients at home and could save financially.

After-hospital care packages vary between hospitals but unplanned hospital readmissions were thought to cost the NHS in England £2bn per year, noted the study authors.

They looked at more than 55,000 anonymised records from intensive care patients in Scotland, finding one in four experienced unplanned readmissions within three months of leaving hospital.

The researchers then interviewed 58 ICU patient volunteers and unpaid carers about their wellbeing, care services and other issues they felt contributed to their readmission.

Around half felt their readmission was linked to a “perfect storm” of factors, including carers stress, psychological trauma after facing near-death and poor understanding of health and social care systems.

“I was on my own. Not eating properly. I think that’s how I ended up in hospital”

ICU patient

Contributing factors that were commonly mentioned by patients and carers were grouped into 10 categories, including poor communications between acute and community based care and inadequate psychological care.

One patient, who took part in the study, said: “I’ve suffered with depression for 20 years on and off. It’s reactive depression and this whole thing has been so traumatic. When I got out of hospital it was a downward spiral.”

Another patient, who was interviewed for the study, said: “I have good support from my husband but totally rely on him. Then he wasn’t here. He had two weeks work… I was on my own. Not eating properly. I think that’s how I ended up in hospital.”

The researchers said the findings highlighted the need for services to take into account complex psychological and social needs, and to better support patients in the months after leaving hospital.

“Complex health and psychosocial issues contribute concurrently to early re-hospitalisation”

Study authors

The government-funded study, published in the journals Thorax and BMJ Quality and Safety, was carried out by the University of Edinburgh, Edinburgh Napier University and the University of Dundee.

“Although some readmissions are medically unavoidable, for many ICU survivors complex health and psychosocial issues contribute concurrently to early re-hospitalisation,” said the study authors.

“Care pathways that anticipate and institute anticipatory multifaceted support for these patients merit further development and evaluation,” they added in BMJ Quality and Safety.

Lead author Professor Tim Walsh, director of the Edinburgh Critical Care Research Group at Edinburgh University, said: “This is a fascinating chance to learn from patients and understand avoidable reasons why they might be readmitted to hospital, so that we might spot those most at risk.

“Our findings show that we have some way to go to improve quality of life for intensive care survivors,” he said.

“We have launched a further project to improve the care of the most vulnerable patients by bringing together staff and charities working in hospitals, community health and social care,” he added.

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