Factors Associated With the Increasing Rates of Discharges Directly Home From Intensive Care Units—A Direct From ICU Sent Home Study

Lau, Vincent; Priestap, Fran; Lam, Joyce; Ball, Ian

doi:10.1177/0885066616668483

Cited by 25 publications

(72 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Similar findings have been reported from multiple groups, giving external validity to our data (30, 31). Discharge to home directly from the ICU was associated with better outcome, presumably as patients in this group were younger with fewer comorbidities and reversible single system pathology, in keeping with the findings of Lau et al (32).…”

Section: Discussionsupporting

confidence: 86%

Risk Factors for 1-Year Mortality and Hospital Utilization Patterns in Critical Care Survivors: A Retrospective, Observational, Population-Based Data Linkage Study*

Szakmány

Walters

Pugh

et al. 2019

Critical Care Medicine

View full text Add to dashboard Cite

Objective Clear understanding of the long-term consequences of critical care survivorship is essential. We investigated the care process and individual factors associated with long-term mortality among ICU survivors and explored hospital use in this group. Design Population based data linkage study using the Secure Anonymised Information Linkage (SAIL) databank. Setting All ICUs between 2006-2013 in Wales, UK. Patients We identified 40,631 patients discharged alive from Welsh adult ICUs. Intervention none. Measurements and Main results Primary outcome was 365-day survival. The secondary outcomes were 30 and 90-day survival and hospital utilisation in the 365 days following ICU discharge. Kaplan-Meier curves were plotted to compare survival rates. Cox proportional hazards regression models were used to determine risk factors of mortality. 7,883 (19.4%) patients died during the 1-year follow-up period. In the multivariable Cox regression analysis, advanced age and comorbidities were significant determinants of long-term mortality. Expedited discharge due to ICU bed shortage was associated with higher risk. The rate of hospitalisation in the year prior to the critical care admission was 28 hospitalised days/1000 days, post critical care was 88 hospitalised days/1000 days for those who were still alive; and 57 hospitalised days/1000 days and 412 hospitalised days/1000 days for those who died by the end of the study, respectively. Conclusions One in five ICU survivors die within one year, with advanced age and comorbidity being significant predictors of outcome, leading to high resource use. Care process factors indicating high system stress were associated with increased risk. More detailed understanding is needed on the effects of the potentially modifiable factors to optimise service delivery and improve long-term outcomes of the critically ill.

show abstract

Section: Discussionsupporting

confidence: 86%

Risk Factors for 1-Year Mortality and Hospital Utilization Patterns in Critical Care Survivors: A Retrospective, Observational, Population-Based Data Linkage Study*

Szakmány

Walters

Pugh

et al. 2019

Critical Care Medicine

View full text Add to dashboard Cite

show abstract

“…For example, insurance status, race, and home situation have been associated with readmission risk. 5 Patients discharged directly from the ICU appear no different. Care coordinators, social workers, and others who focus on designing safe transition plans with the appropriate patient support systems in place may not typically see patients in the ICU, since most patients are not discharged home from the ICU.…”

Section: Invited Commentarymentioning

confidence: 99%

“…2,3 However, long waits for hospital ward beds in many health care systems have resulted in a new model of care where select patients recovering from critical illness are discharged directly home from the ICU. 4,5 The discharge of preterm infants directly home from neonatal ICUs has been well described, shown in randomized clinical trials to be safe and efficient, 6,7 and endorsed in guidelines from professional societies. 8 Conversely, the discharge of adult patients directly home from the ICU has only been recently described, 5,[9][10][11][12][13] has not been comparatively evaluated with the historical model of patient discharge via the hospital ward, and is not mentioned in guidelines from professional societies.…”

mentioning

confidence: 99%

Assessment of the Safety of Discharging Select Patients Directly Home From the Intensive Care Unit

et al. 2018

View full text Add to dashboard Cite

IMPORTANCE The safety of discharging adult patients recovering from critical illness directly home from the intensive care unit (ICU) is unknown.OBJECTIVE To compare the health care utilization and clinical outcomes for ICU patients discharged directly home from the ICU with those of patients discharged home via the hospital ward. DESIGN, SETTING, AND PARTICIPANTSRetrospective population-based cohort study of adult patients admitted to the ICU of 9 medical-surgical hospitals from January 1, 2014, to January 1, 2016, with 1-year follow-up after hospital discharge. All adult ICU patients were discharged home alive from hospital, and the propensity score matched cohort (1:1) was based on patient characteristics, therapies received in the ICU, and hospital characteristics.EXPOSURES Patient disposition on discharge from the ICU: directly home vs home via the hospital ward. MAIN OUTCOMES AND MEASURESThe primary outcome was readmission to the hospital within 30 days of hospital discharge. The secondary outcomes were emergency department visit within 30 days and death within 1 year. RESULTS Among the 6732 patients included in the study, 2826 (42%) were female; median age, 56 years (interquartile range, 41-67 years); 922 (14%) were discharged directly home, with significant variation found between hospitals (range, 4.4%-44.0%). Compared with patients discharged home via the hospital ward, patients discharged directly home were younger (median age 47 vs 57 years; P < .001), more likely to be admitted with a diagnosis of overdose, substance withdrawal, seizures, or metabolic coma (32% [295] vs 10% [594]; P < .001), to have a lower severity of acute illness on ICU admission (median APACHE II score 15 vs 18; P < .001), and receive less than 48 hours of invasive mechanical ventilation (42% [389] vs 34% [1984]; P < .001). In the propensity score matched cohort (n = 1632), patients discharged directly home had similar length of ICU stay (median, 3.1 days vs 3.0 days; P = .42) but significantly shorter length of hospital stay (median, 3.3 days vs 9.2 days; P < .001) compared with patients discharged home via the hospital ward. There were no significant differences between patients discharged directly home or home via the hospital ward for readmission to the hospital (10% [n = 81] vs 11% [n = 92]; hazard ratio [HR], 0.88; 95% CI, 0.64-1.20) or emergency department visit (25% [n = 200] vs 26% [n = 212]; HR, 0.94; 95% CI, 0.81-1.09) within 30 days of hospital discharge. Four percent of patients in both groups died within 1 year of hospital discharge (n = 31 and n = 34 in the discharged directly home and discharged home via the hospital ward groups, respectively) (HR, 0.90; 95% CI, 0.60-1.35). CONCLUSIONS AND RELEVANCEThe discharge of select adult patients directly home from the ICU is common, and it is not associated with increased health care utilization or increased mortality.

show abstract

“…Also, the rate of direct-to-home discharges from the ICU also tend to increase [5] because the beds in the ICU and on wards are becoming unavailable and the support of local communities and the quality of medical care have improved [6].…”

Section: Introductionmentioning

confidence: 99%

“…Therefore, factors related to the state of rehabilitation in ICU patients should be taken into consideration when planning discharge. Nevertheless, in relation to these previously mentioned factors [6,7,9,13], no studies of factors related to discharge have considered the effects of early rehabilitation in the ICU during hospitalization.…”

Section: Introductionmentioning

confidence: 99%

Factors Affecting Discharge to Home of Medical Patients Treated in an Intensive Care Unit

Shimogai

Izawa

Kawada

et al. 2019

IJERPH

View full text Add to dashboard Cite

The purpose of this study was to examine the factors affecting the discharge to home of medical patients treated in an intensive care unit, including elements of in-hospital rehabilitation and prehospital movement ability. The participants of this retrospective cohort study were medical patients treated in an intensive care unit (ICU) and who began rehabilitation in ICU. We assessed the participants in the ICU and analyzed data on patient background, hospitalization, and rehabilitation status. There were 155 ICU patients available for analysis. A multivariable logistic regression model identified the four variables of age (OR 1.06, 95% CI 1.02–1.09), APACHE II score (OR 1.12, 95% CI 1.04–1.24), independence in home life before admission (OR 7.10, 95% CI 1.65–30.44), and standing within 5 days of admission (OR 6.58, 95% CI 2.60–16.61) as factors significantly related to discharge from hospital to home. Independence of home life before admission and early start of standing were identified as factors strongly related to discharge to home. The degree of independence in living before hospital admission and progress toward early mobilization are helpful when considering an ICU patient’s discharge destination.

show abstract

Factors Associated With the Increasing Rates of Discharges Directly Home From Intensive Care Units—A Direct From ICU Sent Home Study

Cited by 25 publications

References 21 publications

Risk Factors for 1-Year Mortality and Hospital Utilization Patterns in Critical Care Survivors: A Retrospective, Observational, Population-Based Data Linkage Study*

Risk Factors for 1-Year Mortality and Hospital Utilization Patterns in Critical Care Survivors: A Retrospective, Observational, Population-Based Data Linkage Study*

Assessment of the Safety of Discharging Select Patients Directly Home From the Intensive Care Unit

Factors Affecting Discharge to Home of Medical Patients Treated in an Intensive Care Unit

Contact Info

Product

Resources

About