Standardizing Intensive Care Unit Discharge Through Use of the National Early Warning Score

Background No standardized process for determining intensive care unit discharge readiness is available. Intensive care unit readmission is associated with adverse patient outcomes. Objective To evaluate whether implementation of an intensive care unit discharge protocol based on the National Early Warning Score impacts intensive care unit readmission rates, intensive care unit length of stay, and rapid response team activations. Methods This quality improvement initiative was implemented in the medical intensive care unit at a 671-bed urban, academic medical center. De-identified electronic medical record data (vital signs, length of intensive care unit stay, and readmission risk factors) were obtained before and during the intervention. Results Two hundred ten patients during the preintervention phase and 211 patients during the intervention phase met inclusion criteria. A nonsignificant 1.5% reduction in intensive care unit readmission rate was found (P = .54). Mean National Early Warning Score at intensive care unit discharge for patients who required readmission was significantly higher in the preintervention group (P = .004), and significantly more patients in the preintervention group were discharged with a National Early Warning Score indicating high risk (P = .04). Length of stay and rapid response team activations did not significantly differ between groups. All readmitted patients had readmission risk factors, most commonly respiratory reasons and vital sign abnormalities. Conclusion An intensive care unit discharge protocol provides standardization to the discharge process and promotes collaboration between nurses and physicians. Future research on a National Early Warning Score–driven intensive care unit discharge protocol is needed.