Hamsen U, Waydhas C, Wildenauer R, Schildhauer T A, Schwenk W
Chirurgische Klinik, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bürkle de la Camp-Platz 1, 44789, Bochum, Deutschland.
Medizinische Fakultät, Universität Duisburg-Essen, Essen, Deutschland.
Chirurg. 2018 Apr;89(4):289-295. doi: 10.1007/s00104-018-0599-0.
Unplanned admissions or readmissions to the intensive care unit lead to a poorer outcome and present medical, logistic and economic challenges for a clinic. How often and what are the reasons for readmission to the intensive care unit? Which strategies and guidelines to avoid readmission are recommended.
Analysis and discussion of available studies and recommendations of national and international societies.
Many studies show that unplanned admissions and readmissions to the intensive care unit represent an independent risk factor for a poor outcome for patients. Different factors that increase the probability of readmission can be identified. Structural changes concerning the normal wards, intensive care unit or the clinic internal emergency service could positively effect readmission rates and/or patient outcome while other studies failed to show any effect of these arrangements.
Patient transition from the intensive care unit to a lower level of care is a critical point of time and has to be accompanied by a high quality handover. Unstable patients on normal wards have to be identified and treated as soon as possible but effects of standardized medical emergency teams are controversial.
重症监护病房的非计划入院或再入院会导致更差的预后，并给临床带来医疗、后勤和经济方面的挑战。重症监护病房再入院的频率如何，原因是什么？推荐哪些避免再入院的策略和指南？
对现有研究以及国家和国际协会的建议进行分析和讨论。
许多研究表明，重症监护病房的非计划入院和再入院是患者预后不良的独立危险因素。可以确定增加再入院可能性的不同因素。普通病房、重症监护病房或医院内部急诊服务的结构变化可能对再入院率和/或患者预后产生积极影响，而其他研究未能显示这些安排有任何效果。
患者从重症监护病房过渡到较低护理级别是一个关键时间点，必须伴有高质量的交接。必须尽快识别并治疗普通病房中不稳定的患者，但标准化医疗急救团队的效果存在争议。
