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Unplanned early hospital readmission among critical care survivors: a mixed methods study of patients and carers
  1. Eddie Donaghy1,
  2. Lisa Salisbury2,
  3. Nazir I Lone3,
  4. Robert Lee3,
  5. Pamela Ramsey4,
  6. Janice E Rattray5,
  7. Timothy Simon Walsh1
  1. 1Department of Anaesthesia, Critical Care and Pain Medicine, The University of Edinburgh, Edinburgh, UK
  2. 2School of Health Sciences, Queen Margaret University Edinburgh, Musselburgh, UK
  3. 3Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
  4. 4School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
  5. 5School of Nursing and Health Sciences, University of Dundee, Dundee, UK
  1. Correspondence to Dr Timothy Simon Walsh, Department of Anaesthesia, Critical Care and Pain Medicine, University of Edinburgh, Edinburgh EH8 9YL, UK; twalsh{at}staffmail.ed.ac.uk

Abstract

Background Many intensive care (ICU) survivors experience early unplanned hospital readmission, but the reasons and potential prevention strategies are poorly understood. We aimed to understand contributors to readmissions from the patient/carer perspective.

Methods This is a mixed methods study with qualitative data taking precedence. Fifty-eight ICU survivors and carers who experienced early unplanned rehospitalisation were interviewed. Thematic analysis was used to identify factors contributing to readmissions, and supplemented with questionnaire data measuring patient comorbidity and carer strain, and importance rating scales for factors that contribute to readmissions in other patient groups. Data were integrated iteratively to identify patterns, which were discussed in five focus groups with different patients/carers who also experienced readmissions. Major patterns and contexts in which unplanned early rehospitalisation occurred in ICU survivors were described.

Results Interviews suggested 10 themes comprising patient-level and system-level issues. Integration with questionnaire data, pattern exploration and discussion at focus groups suggested two major readmission contexts. A ‘complex health and psychosocial needs’ context occurred in patients with multimorbidity and polypharmacy, who frequently also had significant psychological problems, mobility issues, problems with specialist aids/equipment and fragile social support. These patients typically described inadequate preparation for hospital discharge, poor communication between secondary/primary care, and inadequate support with psychological care, medications and goal setting. This complex multidimensional situation contrasted markedly with the alternative ‘medically unavoidable’ readmission context. In these patients medical issues/complications primarily resulted in hospital readmission, and the other issues were absent or not considered important.

Conclusions Although some readmissions are medically unavoidable, for many ICU survivors complex health and psychosocial issues contribute concurrently to early rehospitalisation. Care pathways that anticipate and institute anticipatory multifaceted support for these patients merit further development and evaluation.

  • critical care
  • patient-centred care
  • qualitative research
  • transitions in care
  • health services research

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Footnotes

  • Handling editor Natalie Armstrong

  • Contributors All authors contributed to conception and design of the work. ED and LS undertook interviews and focus groups, and contributed to data acquisition and analysis. All authors contributed to interpretation of data for the work. ED and TSW drafted the manuscript. All authors revised it critically for important intellectual content. All authors gave final approval of the version to be published. All authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding This study was funded through a research grant from the Chief Scientist Office for Scotland (10.13039/501100000589) (grant number CZH/401026).

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval The local research ethics committee provided approval (SE Scotland Research Ethics Committee 2 (14/SS/1032)).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement All data collected in this study were used in the manuscript. The transcript files from the interviews and focus groups are available for further study for relevant research questions. Requests to access the data should be directed to the corresponding author.

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