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Little is known about direct discharge of patients from the intensive care unit (ICU) to home. To learn more about this process, researchers retrospectively evaluated >6700 adult patients who were admitted to ICUs in nine Canadian hospitals, 14% of whom were discharged directly to home. Patients discharged to home were younger than those transferred to wards (median ages, 47 vs. 57) and were more likely to have been admitted with overdose, seizure, substance withdrawal, or metabolic coma.
The 816 patients who were discharged directly to home were propensity matched with an equal number of patients who were transferred to hospital wards. Matching involved patient characteristics (e.g., comorbidities, ICU diagnosis, severity-index scores), therapies in the ICU (e.g., mechanical ventilation, vasopressors, renal replacement therapy), and hospital characteristics. Forty percent of patients in each cohort spent >24 hours waiting for floor transfers. Within 30 days of hospital discharge, hospital readmissions (≈10%) and emergency department revisits (≈25%) were similar in both groups; 1-year mortality (4%) also was similar.
Stelfox HT et al. Assessment of the safety of discharging select patients directly home from the intensive care unit: A multicenter population-based cohort study. JAMA Intern Med 2018 Aug 20; [e-pub]. (https://doi.org/10.1001/jamainternmed.2018.3675)
Comment
Discharging patients to home directly from the ICU appears to be safe for patients who are admitted for substance-related disorders, seizures, or metabolic derangements. Lack of non-ICU bed availability on the hospital wards affects ICU discharges. As hospital censuses rise, identifying and facilitating safe ICU discharge of stable patients directly to home could help prevent bottlenecking and improve hospital flow.