Critical Care Medicine Service, Department of Anesthesiology and Critical Care Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
J Crit Care. 2012 Dec;27(6):681-7. doi: 10.1016/j.jcrc.2012.05.009. Epub 2012 Aug 16.
The objectives of our study were to evaluate the characteristics and outcomes of patients discharged home directly from an oncologic intensive care unit (ICU) and their 30-day hospital readmission patterns.
We retrospectively reviewed ICU discharges over 3 years (2008-2010) and identified patients who were discharged directly home. Demographic, clinical, ICU discharge, and 30-day hospital readmission and mortality rates were analyzed.
Ninety-five patients (3.6%) were discharged home directly from the ICU (average annual rate of 3.9%). ICU diagnoses primarily included respiratory insufficiency, sepsis, cardiac syndromes, and gastrointestinal bleeding. Home discharge occurred most commonly between Thursday and Saturday. Five (5.3%) patients, including 2 hospice patients, died within 30 days of ICU home discharge. Thirty (31.6%) patients were readmitted within 30 days of discharge. The unplanned 30-day readmission rate was 23.2% (22/95) with a median time to hospital readmission of 13 (8-18) days. Most (64%) of the unplanned readmissions were related to the initial ICU admission.
Home discharge of ICU patients at our institution is infrequent but consistent. Almost one third of these patients were readmitted to the hospital within 30 days. Enhancements to the ICU home discharge process may be required to ensure optimal post-ICU care.
本研究的目的是评估直接从肿瘤重症监护病房（ICU）出院的患者的特征和结局及其 30 天内的再入院模式。
我们回顾性分析了 3 年（2008-2010 年）的 ICU 出院患者，并确定了直接出院回家的患者。分析了人口统计学、临床、ICU 出院和 30 天内医院再入院和死亡率。
95 例（3.6%）患者直接从 ICU 出院回家（平均年出院率为 3.9%）。ICU 的诊断主要包括呼吸功能不全、败血症、心脏综合征和胃肠道出血。出院最常见于周四至周六。5 例（5.3%）患者，包括 2 例临终关怀患者，在 ICU 出院后 30 天内死亡。30 例（31.6%）患者在出院后 30 天内再次入院。计划外的 30 天再入院率为 23.2%（22/95），中位再入院时间为 13（8-18）天。大多数（64%）未计划再入院与最初的 ICU 入院有关。
本机构 ICU 患者的家庭出院情况并不常见，但较为稳定。其中近三分之一的患者在 30 天内再次入院。可能需要改进 ICU 家庭出院流程，以确保 ICU 后最佳护理。
