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A standardized check before patients leave the intensive care unit may help clinicians identify those not ready to step down to a general medical floor, potentially preventing some patients from returning to the ICU within days.
A quality-improvement initiative in the 28-bed medical ICU at Rush University Medical Center in Chicago incorporated the National Early Warning Score, or NEWS, into discharge readiness assessments. Within a few months, the unit’s ICU readmission rate fell by 1.5%, and the number of patients discharged with a NEWS of 7 or higher fell by 5.2%.
The results, published in Critical Care Nurse, were enough for the medical ICU to adopt the protocol permanently.
For nurses, one notable finding was how often the additional assessment affected discharge plans.
Nearly 70% of registered nurses surveyed during the initiative reported experiencing a patient’s ICU discharge being delayed or canceled because of the NEWS protocol. Half of physicians reported the same.
“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,” lead author Abigail Weilbacher, DNP, RN, CCRN, 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.”
Why ICU Discharge Readiness Matters
Deciding when a critically ill patient is stable enough to leave the ICU can be complicated, particularly in medical ICUs caring for patients with a wide range of conditions.
Before the initiative, the Rush medical ICU had a higher rate of patients returning within 72 hours of discharge than the hospital’s more specialized cardiovascular and neurological ICUs. These returns, sometimes called “bounce-back” readmissions, are associated with longer hospital stays and higher mortality.
The pilot added a standardized measure to the clinical decision-making already taking place before a transfer.
NEWS uses six common vital signs and physiological measurements to generate a score ranging from 0 to 20. Higher scores indicate a greater risk for clinical deterioration. Under the Rush protocol, a score indicating moderate to high risk prompted further assessment before transfer rather than automatically determining whether a patient could leave the ICU.
For nurses and the broader interprofessional team, the protocol provided a common measure to consider alongside the patient’s overall clinical picture.
Fewer Patients Returned to the ICU
Researchers reviewed electronic medical records from Nov. 1, 2024, through April 15, 2025.
The analysis included 421 patients, with 210 evaluated before the NEWS protocol was introduced and 211 after implementation. Of those, 15 were readmitted to the medical ICU before the intervention, compared with 12 after the protocol was introduced.
All patients who returned to the ICU had readmission risk factors, most commonly respiratory issues and vital sign abnormalities.
The mean ICU length of stay and incidence of rapid response team activations after ICU discharge were largely comparable between the two groups.
The authors noted that differences between the two periods were often not statistically significant. The findings therefore do not show that the NEWS protocol itself caused the reduction in ICU readmissions.
Still, the clinical outcomes and overall staff response were enough for the medical ICU to continue using the protocol.
Nurses Strongly Supported Keeping the Protocol
More than 95% of nurses surveyed wanted to continue the NEWS protocol.
Physicians were less certain. Among physicians surveyed, 41.2% supported continued use, while nearly half said they were unsure.
The difference is notable because bedside nurses play a central role in monitoring the physiological changes that can signal whether a patient is ready to transition to a lower level of care.
The initiative also shows how routinely collected physiological measurements can become a standardized checkpoint during a consequential transition in care.
In the Rush medical ICU, NEWS did not replace clinical judgment. It provided another piece of information for the interprofessional team to consider before finalizing a transfer.
