Initiative Standardizes Discharge Readiness Evaluation

ALISO VIEJO, Calif. - Oct. 1, 2026 – A standardized process to evaluate patients for their readiness to be discharged from an intensive care unit (ICU) can help reduce readmissions while providing clarity and supporting collaboration among the interprofessional team, according to a study published in Critical Care Nurse (CCN).

A quality-improvement initiative in the 28-bed medical ICU at Rush University Medical Center, Chicago, introduced the unit staff to the National Early Warning Score (NEWS) to support decision-making prior to transferring patients to other units. The NEWS tool uses six common vital signs and physiological measurements as the basis for a score of 0-20, with higher scores signifying greater risk for clinical deterioration.

“Standardizing Intensive Care Unit Discharge Through Use of the National Early Warning Score” details how the pilot protocol quickly proved its value to the unit, even though preintervention and intervention data were often not significantly different.

Within a couple of months, the initiative contributed to a 1.5% reduction in the readmission rate to the unit and a 5.2% reduction in the number of patients discharged with a NEWS of 7 or greater. The clinical outcomes and overall positive response from nurses and physicians led to the protocol’s permanent implementation in the unit.

Lead author Abigail Weilbacher, DNP, RN, CCRN, is a critical care clinical education scholar at OSF HealthCare, Bloomington, Illinois. The initiative was conducted as part of her doctor of nursing practice studies at Mennonite College of Nursing, Illinois State University, Normal, while she was assistant unit director of the medical ICU at Rush.

“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,” she said. “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.”

Prior to the initiative, the medical ICU’s readmission rate for patients who returned to the ICU within 72 hours of their initial discharge was greater than that of the more specialized cardiovascular and neurological ICUs. These so-called “bounce back” readmissions are associated with longer hospital stays and higher mortality.

Nurses and physicians were surveyed before the initiative and again during the evaluation of the NEWS protocol. Nearly 70% of registered nurses and 50% of physicians experienced a patient’s discharge being delayed or canceled because of the NEWS protocol. This finding implies that after the patient’s NEWS was assessed, the patient was deemed currently not ready for discharge, and the plan of care was updated, with the patient’s readiness for ICU discharge reevaluated later.

In addition, more than 95% of nurses wanted to continue using the protocol, with mixed feedback from physicians; 41.2% of physicians supported continued use and nearly half indicated they were unsure.

Retrospective reviews of electronic medical records were performed between Nov. 1, 2024, and April 15, 2025, to collect data and determine eligibility criteria. A total of 210 patients met inclusion criteria during the preintervention period of Nov. 1, 2024, to Jan. 31, 2025. The intervention began Feb. 10, 2025, and ended April 15, 2025, with data from 211 patients.

Of the 421 patients who met inclusion criteria during the full study period, 15 were readmitted to the medical ICU during the preintervention phase, while 12 were readmitted in the intervention phase. All readmitted patients had readmission risk factors, most commonly respiratory reasons and vital sign abnormalities.

The mean ICU length of stay and incidence of rapid response team activations following ICU discharge were largely comparable between the preintervention and intervention groups.

As AACN’s bimonthly clinical practice journal for acute and critical care nurses, CCN is a trusted source of information related to the bedside care of critically and acutely ill patients. Access the article abstract and full-text PDF by visiting the CCN website at http://ccn.aacnjournals.org.

About Critical Care Nurse: Critical Care Nurse (CCN) a bimonthly clinical practice journal published by the American Association of Critical-Care Nurses, provides current, relevant and useful information about the bedside care of critically and acutely ill patients. The award-winning journal also offers columns on traditional and emerging issues across the spectrum of critical care, keeping critical care nurses informed on topics that affect their practice in acute, progressive and critical care settings. CCN enjoys a circulation of more than 136,000 and can be accessed at https://ccn.aacnjournals.org.

About the American Association of Critical-Care Nurses: For more than 55 years, the American Association of Critical-Care Nurses (AACN) has been dedicated to acute and critical care nursing excellence. The organization’s vision is to create a healthcare system driven by the needs of patients and families in which acute and critical care nurses make their optimal contribution. AACN is the world’s largest specialty nursing organization, with more than 136,000 members and about 170 chapters in the United States.

American Association of Critical-Care Nurses
27071 Aliso Creek Road, Aliso Viejo, CA 92656; 949-362-2000; www.aacn.org