Introduction

Hospital-based intensive care is known to be a significant driver of healthcare costs. In the USA, intensive care unit (ICU) care accounted for 13% of all hospital costs in 2005.1 One aspect of ICU care that has been found to be both a driver of cost and a measure of quality is ICU readmissions.1 As a result, readmission to the ICU within a single hospitalisation is now viewed by payers as a potential preventable complication, and payers are beginning to propose denial of charges associated with these episodes of care given the impact on length of stay (LOS) and hospital charges.2 Examples from the literature include data from an adult medicine multicentre database enquiry that demonstrated that patients who were readmitted to an ICU have a 2.5-fold increase in hospital LOS compared with patients who were not readmitted.3 Furthermore, Magruder et al 4 demonstrated a 128% increase in hospital charges associated with an ICU readmission, and this trend was present despite risk adjustment for patient severity of illness.4

Over recent decades there has been a significant reduction in the congenital heart disease mortality rate.3 As a result, increasing emphasis has been placed on reducing morbidity and identifying markers of care delivery such as hospital LOS and incidence of hospital readmission.5 The paediatric cardiac population is at particular risk for in-hospital deterioration and subsequent readmission to the cardiac intensive care unit (CICU).6 However, while studies have described that in-hospital readmission to the paediatric CICU is associated with mortality,5 6 there is little data on efforts aimed at preventing these readmissions. It is notable that benchmark data do not exist for this metric; however, our internal single-centre data demonstrated that 2.8% of our patients who were transferred from the CICU to the cardiac step-down unit …