Characteristics and Outcomes of Patients Discharged Directly Home from a Medical Intensive Care Unit

Authors

Preeyal M. Patel, Thomas Jefferson UniversityFollow
Michele Fiorella, MS, Thomas Jefferson UniversityFollow
Ann Zheng, Thomas Jefferson UniversityFollow
Erika J. Yoo, MD, Thomas Jefferson UniversityFollow

Document Type

Abstract

Publication Date

1-2020

Academic Year

2019-2020

Abstract

Introduction: Discharging patients directly home from the ICU is becoming increasingly common, largely driven by decreased ward bed availability. We evaluated readmission patterns of ICU patients discharged directly home.

Methods: Retrospective review was conducted of direct discharges from the ICU to home between June 2017 and June 2019. The primary outcome of interest was 30-day hospital readmission. Patients were dichotomized by “wait-time” between transfer order and hospital discharge (<24 hours or ≥24 hours). Outcomes were compared using t-test, Fisher exact, and chi-squared. Risk-adjustment was performed using the Mortality Probability Model (MPM₀-III). ICU workload was estimated using the nine equivalents of nursing manpower use score (NEMS).

Results: 331 patients were identified, with a mean time of 0.72 [0 - 5.84] days between ICU transfer order and discharge to home. 68.3% (226/331) of patients waited <24 hours for discharge. There was no difference in severity-of-illness or admission NEMS between the groups. 10.3% (45/331) of patients presented for evaluation within 30 days of discharge. 10.3% (34/331) of patients were readmitted. There was no significant difference in 30-day readmission between patients who were discharged after waiting <24 hours vs. waiting ≥24 hours (p=0.70).

Discussion: Patients returning directly home from the ICU without discharge delay were not readmitted more frequently within 30 days than those discharged after a delay exceeding 24 hours. Further investigation into identifying patients eligible for safe, early discharge may reduce unnecessary critical care resource utilization.

Recommended Citation

Patel, Preeyal M.; Fiorella, MS, Michele; Zheng, Ann; and Yoo, MD, Erika J., "Characteristics and Outcomes of Patients Discharged Directly Home from a Medical Intensive Care Unit" (2020). Phase 1. Paper 25.
https://jdc.jefferson.edu/si_ctr_2022_phase1/25

Language

English