SHM Converge Scientific Abstract ePoster Gallery-Step Down Without the Step Back: An Icu Downgrade Risk Score

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This quality improvement project developed and tested an electronic health record-based ICU Downgrade Risk Score to help identify medical ICU patients at risk for readmission after transfer out of the ICU.<br /><br />The team created the score by combining literature review, stakeholder interviews, and a retrospective review of MICU patients. Fifteen variables associated with ICU-level care or readmission risk were included and weighted from 1 to 5 points. High-impact factors included vasopressor use, mechanical ventilation, certain agitation/sedation states on the RASS scale, arterial line placement, and elevated MEWS. The score was embedded in the EHR to update every hour and be passively available to hospitalists during transfer decisions.<br /><br />For validation, investigators compared a 6-month pre-implementation cohort with a 3-month post-implementation cohort. They examined median risk scores in the 24 hours before ICU downgrade and used logistic regression to assess associations with readmission. A score cutoff of 3.5 was significantly associated with higher odds of readmission. Patients who were readmitted had a higher median downgrade score than those who were not (5 vs 4, p=0.003). A faster decline in score over the 24 hours before downgrade was associated with lower readmission risk.<br /><br />ICU readmission rates were 1.2% before implementation and 0.6% after implementation, but this difference was not statistically significant. Overall, the score showed good performance in identifying patients at elevated risk for MICU readmission, though the authors note that further refinement and external validation are needed.

Asset Subtitle

Stephen Biederman

Meta Tag

Author List Chantal McHenry, Chris Orange, Hope Kramer, Matthew Ambrosio, Megan Ragusa, Shivani Patel, Stephen Biederman

Category Research

Concept ICU Downgrade Risk Score

Concept Intensive Care Unit Readmission

Concept MICU Transition

Concept Risk Factor

Concept Electronic Health Record

Distinguished Non-Finalist

Presenter Organization VCU Health System

Presenting Author Stephen Biederman

Track Quality Improvement

Keywords

ICU downgrade risk score

electronic health record

MICU readmission

risk stratification

patient transfer

vasopressor use

mechanical ventilation

RASS scale

MEWS

quality improvement

ICU Downgrade Risk Score

Intensive Care Unit Readmission

MICU Transition

Risk Factor

Electronic Health Record