Standardized Scoring Tool Supports ICU Discharge Decisions

When patients deteriorate soon after transfer, “bounce-back” readmissions can prolong hospitalization and increase mortality. These decisions are especially difficult in medical ICUs that care for patients with varied conditions. A new study shows that a standardized scoring process can support ICU discharge readiness assessment.

The quality-improvement initiative was conducted in the 28-bed medical ICU at Rush University Medical Center (Chicago, IL, USA). The protocol introduced use of the National Early Warning Score (NEWS) before transfer to other units. NEWS combines six common vital signs and physiological measurements into a score from 0 to 20, with higher scores indicating greater risk of clinical deterioration.

Before the initiative, the medical ICU had a higher 72-hour readmission rate than the hospital’s more specialized cardiovascular and neurological ICUs. Researchers retrospectively reviewed electronic medical records from November 1, 2024, to April 15, 2025, to collect data and determine eligibility. The preintervention period included 210 patients from November 1, 2024, to January 31, 2025, while the intervention period included 211 patients from February 10, 2025, to April 15, 2025.

Across the full study period, 421 patients met inclusion criteria. Fifteen patients were readmitted to the medical ICU before the intervention, compared with 12 during the intervention phase. Within a few months, the initiative was associated with a 1.5% reduction in the unit readmission rate and a 5.2% reduction in the number of patients discharged with a NEWS of 7 or higher.

Clinician surveys suggested that the protocol influenced discharge decisions. Nearly 70% of registered nurses and 50% of physicians reported that a patient’s discharge had been delayed or canceled because of the NEWS protocol. More than 95% of nurses wanted to continue using the protocol, while 41.2% of physicians supported continued use and nearly half were unsure.

“Medical ICUs provide care for critically ill patients with wide-ranging conditions, and the NEWS tool was an easy-to-use way for clinicians to assess readiness for discharge from the ICU and transfer to the general medical unit. The score became part of the decision-making process before discharge was finalized, and a score that indicated moderate to high risk for deterioration triggered additional assessment,” said Abigail Weilbacher, DNP, RN, CCRN, critical care clinical education scholar at OSF HealthCare.

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Rush University Medical Center