Developing a reflection and analysis tool (We-ReAlyse) for readmissions to the intensive care unit: A quality improvement project

Background: Readmissions to the intensive care unit are associated with poorer patient outcomes and health prognoses, alongside increased lengths of stay and mortality risk. To improve quality of care and patients' safety, it is essential to understand influencing factors relevant to specitic patient populations and settings. A stan-dardized tool for systematic retrospective analysis of readmissions would help healthcare professionals under-stand risks and reasons affecting readmissions; however, no such tool exists. Purpose: This study's purpose was to develop a tool (We-ReAlyse) to analyze readmissions to the intensive care unit from general units by reflecting on affected patients' pathways from intensive care discharge to readmission. The results will highlight case-specitic causes of readmission and potential areas for departmental-and institutional-level improvements.Method: A root cause analysis approach guided this quality improvement project. The tool's iterative develop-ment process included a literature search, a clinical expert panel, and a testing in January and February 2021.Results: The We-ReAlyse tool guides healthcare professionals to identify areas for quality improvement by reflecting the patient's pathway from the initial intensive care stay to readmission. Ten readmissions were analyzed by using the We-ReAlyse tool, resulting in key insights about possible root causes like the handover process, patient's care needs, the resources on the general unit and the use of different electronic healthcare record systems.Conclusions: The We-ReAlyse tool provides a visualization/objectitication of issues related to intensive care readmissions, gathering data upon which to base quality improvement interventions. Based on the information on how multi-level risk protiles and knowledge deticits contribute to readmission rates, nurses can target specitic quality improvements to reduce those rates.Implications for clinical practice and research: With the We-ReAlyse tool, we have the opportunity to collect detailed information about ICU readmissions for an in-depth analysis. This will allow health professionals in all involved departments to discuss and either correct or cope with the identitied issues. In the long term, this will allow continuous, concerted efforts to reduce and prevent ICU readmissions. To obtain more data for analysis and to further retine and simplify the tool, it may be applied to larger samples of ICU readmissions. Furthermore, to test its generalizability, the tool should be applied to patients from other departments and other hospitals. Adapting it to an electronic version would facilitate the timely and comprehensive collection of necessary in-formation. Finally, the tool's emphasis comprises reflecting on and analyzing ICU readmissions, allowing cli-nicians to develop interventions targeting the identitied problems. Therefore, future research in this area will require the development and evaluation of potential interventions.