Long-term Safety of Directly Discharging Patients Home from the ICU Compared to Ward Transfer. (October 2022)

• Record Type: Journal Article
• Authors: Sy, Eric; Gupta, Chiraag; Shahab, Zunaira; Fortin, Nathan; Kassir, Sandy; Mailman, Jonathan F.; Lau, Vincent I.
• Is Part Of: Journal of intensive care medicine. Volume 37:Number 10(2022)
• Page Start: 1344
• Page End: 1352
• Publication Date: 2022-10
• Subjects: patient discharge -- intensive care units -- patient readmission -- mortality -- critical care -- critical care outcomes -- observational study; Critical care medicine -- Periodicals; Critical Care -- Periodicals; Soins intensifs -- Périodiques; Soins intensifs; Périodique électronique (Descripteur de forme); Ressource Internet (Descripteur de forme); 616.02805
• DOI: 10.1177/08850666221090459
• Languages: English
• ISSNs: 0885-0666

Abstract

Purpose: To evaluate the long-term safety of directly discharging intensive care unit (ICU) survivors to their home.Methods: A retrospective observational cohort of 341 ICU survivors who were directly discharged home from the ICU ("direct discharge") or discharged home ≤72 hours after ICU transfer to the ward ("ward transfer") was conducted in Regina, Saskatchewan ICUs between September 1, 2016 and September 30, 2018. The primary outcome was 90-day hospital readmission. Secondary outcomes included 30-day, 90-day, and 365-day emergency department (ED) visits, 30-day and 365-day hospital readmissions, and 365-day mortality. All outcomes were evaluated by multivariable Cox regression after adjustment for demographic and clinical characteristics.Results: Of 341 survivors (25.5% of total ICU visits), 148 (43.4%) patients were direct discharges and 193 (56.6%) were ward transfers. The median age was 46 years (interquartile range, 34-62), 38.4% were female, and 61.8% resided in Regina. Compared to the ward transfer cohort, more patients in the direct discharge cohort had at least one 90-day hospital readmission (30.4% versus 17.1% of patients, adjusted hazard ratio 2.09, 95% confidence interval 1.28-3.40, P = .003), after adjustment. Additionally, there were more 90-day ED visits ( P = .045), and 30-day ( P = .049) and 365-day hospital readmissions ( P = .03), after adjustment.Conclusions: In Saskatchewan, direct discharge compared to ward transfer was associated with an increase in 90-day hospital readmissions, and potentially other clinical outcomes. Further study is necessary.