PROJECT SUMMARY/ABSTRACT
Unplanned ICU admissions from the acute care floor are common and most often related to the
development of respiratory failure or cardiac dysfunction, with respiratory or circulatory impairment the reason
for ICU admission in over 60% of cases. These admissions are associated with high morbidity and mortality
and are accompanied by other important repercussions for patients and their family members, including
inadequate communication and lower family ratings of care. Unplanned ICU admissions are strong indicators
of adverse events, yet little is known about mechanisms underlying these admissions.
Prior work has focused on patient characteristics associated with unplanned ICU admissions, including age
and severity of illness, but there is limited evidence examining non-patient factors that also contribute, such as
human (e.g., clinician), organizational, or technical failures. It is critical to understand how these non-patient
factors affect unplanned ICU admissions, because admissions resulting from these factors may be
preventable. It is also imperative to differentiate between non-patient factors (human vs organizational vs
technical) and their associated mechanisms because they call for unique interventions.
To fill this key knowledge gap, we propose to identify contributing factors and mechanisms for unplanned
ICU admissions and connect these factors and mechanisms to patient- and family-centered outcomes. This
objective will be met by achievement of three specific aims involving a cohort of patients transferred from acute
care to the ICU at an academic medical center, a safety-net hospital, and a community hospital. The first aim
will use root cause analysis to adapt and refine an existing framework for classification of adverse events, the
PRISMA (Prevention and Recovery Information System for Monitoring and Analysis) model. The adapted
PRISMA model will allow us to identify multiple factors – patient, human (e.g., clinician), organizational, and
technical — and associated mechanisms contributing to unplanned ICU admissions. The second aim will
examine associations between factors and mechanisms contributing to unplanned ICU admissions and family
member symptoms of psychological distress, including symptoms of depression, anxiety, and post-traumatic
stress. The final aim will compare ICU-free days and costs of care across factors and mechanisms contributing
to unplanned ICU admissions. Our team has extensive research experience with seriously ill patients and their
family members, with expertise in development of interventions to improve patient- and family-centered
outcomes, medical decision making, healthcare systems, and quality and safety. We are well-positioned to
identify factors and mechanisms contributing to unplanned ICU admissions and generate the knowledge
needed to develop interventions with the greatest potential to improve outcomes for patients, family members,
and the healthcare system.
