Using ICU readmissions as a marker of care quality: Time for a rethink?

Providing quality care to patients in intensive care units (ICUs) is vital, as these units are expensive and in limited supply. Preventable deaths in ICU patients represent not only a human cost, but also a waste of valuable resources. As such, the outcomes of patients admitted to ICUs are often closely examined to ensure these expensive resources have been utilised appropriately. ICU readmission rates are commonly used as a marker of care quality, but this creates significant problems. For example, readmission rates may reflect care delivered after ICU discharge and not before. Furthermore readmission rates may highlight that resources aimed at improving patient outcomes, such as critical care outreach teams, are actually working. This paper describes the limitations of using ICU readmission rates as a marker of care quality.