Abigail Weilbacher

Faculty Advisor: Marilyn A. Prasun, PhD, CCNS, CNL, CHFN, FAHA, FAAHFN

Problem and Project Introduction

Patients are admitted to the intensive care unit (ICU) due to severe illness or trauma and require advanced monitoring and interventions. Annually, the readmission rate to the ICU ranges from 4% to 16.8% and readmission is associated with adverse patient outcomes (Hasswa et al., 2025; Kumar et al., 2024; Stahel et al., 2024). At the project site, there is no standardized evaluation process for assessing ICU discharge readiness. The purpose of this project was to determine if the implementation of an ICU discharge protocol based on the National Early Warning Score (NEWS) would reduce rates of ICU readmission. Secondary outcomes included analyzing the NEWS and Richmond Agitation-Sedation Scale (RASS) scores upon ICU discharge, the impact on ICU LOS and the number of rapid response team (RRT) activations and analyzing risk factors and reasons for readmission. Stakeholders’ perception of the impact of NEWS was measured before and after implementation.

Methods

This quality improvement initiative was conducted in the medical ICU at a 671-bed urban, academic medical center and used a pre-post design. The inclusion criteria were patients aged 18 years or older admitted to the MICU and discharged from the MICU to a general medicine unit. The exclusion criteria were admission to the MICU for less than 24 hours, pregnancy, death while in the MICU, or discharge out of the MICU to an intermediate care unit, hospice, home, or a long-term or skilled nursing facility. The NEWS discharge protocol was implemented prior to each discharge from the MICU. Scores were reviewed by the registered nurse (RN) in collaboration with the medical provider, who determined if the patient was safe to discharge. Deidentified data from the electronic medical record were obtained before and during implementation. Data included vital signs, ICU LOS, and risk factors for readmission.

Findings

A total of 210 patients during the preintervention period and 211 patients during the intervention period met inclusion criteria. A 1.5% decrease in the incidence of readmission was found. The average NEWS at the time of discharge was statistically significant from preintervention to post intervention groups. In the intervention group, fewer patients were discharged with a NEWS greater than or equal to seven. There was no significant difference in RASS, LOS, or RRT activations. All readmitted patients had risk factors for readmission, and the most common reasons for readmission included respiratory and vital signs abnormalities. The survey responses suggested adherence to the protocol, and nearly 70% of RNs and 50% of medical providers experienced a patient having their discharge delayed or cancelled because of the NEWS protocol.

Practice Implications

An ICU discharge protocol provides standardization to the discharge process and promotes collaboration between RNs and medical providers. The NEWS may facilitate recognition of early signs of deterioration and reduce readmission to the ICU.

Dissemination: Plan to publish in CriticalCareNurse.

References

Hasswa, M. K., Elshazly, M., Osman, M. N., & Tantawy, A. A. (2025). Risk factors and associated outcomes of respiratory ICU readmission. The Egyptian Journal of Bronchology, 19(45). https://doi.org/10.1186/s43168-025-00402-5.

Kumar, R., Singh, B. P., Arshad, Z., Srivastava, V. K., Prakash, R., & Singh, M. K. (2024). Determinants of readmission in the intensive care unit: A prospective observational study. Cureus, 16(6). https://doi.org/10.7759/cureus.62840.

Stahel, P. F., Belk, K. W., McInnis, S. J., Holland, K., Nanz, R., Beals, J., Gosnell, J., Ogundele, O., & Mastriani, K. S. (2024). The Rothman Index predicts unplanned readmissions to intensive care associated with increased mortality and hospital length of stay: A propensity-matched cohort study. Patient Safety in Surgery, 18(10). https://doi.org/10.1186/s13037-024-00391-2.