Research Summary

NEWS-Based ICU Discharge Protocol Shows No Significant Readmission Change

Edited by:
Ashton L. Stahl

Key Highlights

  • ICU readmission rates decreased by a nonsignificant 1.5% after implementation of a National Early Warning Score (NEWS)-based discharge protocol (P = .54).
  • Significantly more patients were discharged with high-risk NEWS values before the intervention than during implementation (P = .04).
  • ICU length of stay and rapid response team activations were not significantly different between groups.
  • The authors concluded that a discharge protocol standardizes the process and promotes nurse–physician collaboration.

A quality improvement initiative published in Critical Care Nurse found that a medical intensive care unit discharge protocol based on the National Early Warning Score (NEWS) did not significantly reduce ICU readmissions. However, the investigators reported differences in NEWS values at discharge between the preintervention and intervention groups, including the proportion of patients discharged with high-risk scores.

The initiative addressed the absence of a standardized process for determining ICU discharge readiness. The authors noted that ICU readmission is associated with adverse patient outcomes and evaluated whether a NEWS-based protocol affected readmission rates, ICU length of stay, and rapid response team activations.

The authors implemented the protocol in the medical ICU of a 671-bed urban academic medical center. Investigators obtained de-identified electronic medical record data before and during implementation, including vital signs, ICU length of stay, and readmission risk factors.

The analysis included 210 patients who met inclusion criteria during the preintervention phase and 211 during the intervention phase. Investigators compared outcomes between these groups and assessed NEWS values at ICU discharge.

Study Findings

The investigators reported a nonsignificant 1.5% reduction in the ICU readmission rate (P = .54). Among patients who subsequently required readmission, the mean NEWS at ICU discharge was significantly higher in the preintervention group than in the intervention group (P = .004). Significantly more patients in the preintervention group were also discharged with a NEWS indicating high risk (P = .04).

Neither ICU length of stay nor rapid response team activations differed significantly between groups. All readmitted patients had readmission risk factors; respiratory reasons and vital sign abnormalities were most common.

Clinical Implications

According to the authors, an ICU discharge protocol standardizes the discharge process and promotes collaboration between nurses and physicians. The authors called for additional research on a NEWS-driven ICU discharge protocol.

Expert Commentary

“An intensive care unit discharge protocol provides standardization to the discharge process and promotes collaboration between nurses and physicians,” the researchers concluded.

Reference

Weilbacher A, Prasun MA, Cook H. Standardizing intensive care unit discharge through use of the National Early Warning Score. Crit Care Nurse. 2026;46(5). doi:10.4037/ccn2026340