Lau Vincent I, Priestap Fran A, Lam Joyce N H, Ball Ian M
1 Division of Critical Care, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
2 Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada.
J Intensive Care Med. 2018 Feb;33(2):121-127. doi: 10.1177/0885066616668483. Epub 2016 Sep 20.
To evaluate the relationship between rates of discharge directly to home (DDH) from the intensive care unit (ICU) and bed availability (ward and ICU). Also to identify patient characteristics that make them candidates for safe DDH and describe transfer delay impact on length of stay (LOS).
Retrospective cohort study of all adult patients who survived their stay in our medical-surgical-trauma ICU between April 2003 and March 2015.
Median age was 49 years (interquartile range [IQR]: 33.5-60.4), and the majority of the patients were males (54.8%). Median number of preexisting comorbidities was 5 (IQR: 2-7) diagnoses. Discharge directly to home increased from 28 (3.1% of all survivors) patients in 2003 to 120 (12.5%) patients in 2014. The mean annual rate of DDH was between 11% and 12% over the last 6 years. Approximately 62% (n = 397) of patients waited longer than 4 hours for a ward bed, with a median delay of 2.0 days (IQR: 0.5-4.7) before being DDH. There was an inverse correlation between ICU occupancy and DDH rates ( r = -.55, P < .0001, 95% confidence interval [CI] = -0.36 to -0.69, R = .29). There was no correlation with ward occupancy and DDH rates ( r = -.055, P = .64, 95% CI = -0.25 to 0.21).
The DDH rates have been increasing over time at our institution and were inversely correlated with ICU bed occupancy but were not associated with ward occupancy. The DDH patients are young, have few comorbidities on admission, and few discharge diagnoses, which are usually reversible single system problems with low disease burden. Transfers to the ward are delayed in a majority of cases, leading to increased ICU LOS and likely increased overall hospital LOS as well.
评估重症监护病房（ICU）直接出院回家（DDH）率与床位可用性（病房和ICU）之间的关系。同时确定使患者成为安全DDH候选者的患者特征，并描述转运延迟对住院时间（LOS）的影响。
对2003年4月至2015年3月期间在我们的内科-外科-创伤ICU住院并存活的所有成年患者进行回顾性队列研究。
中位年龄为49岁（四分位间距[IQR]：33.5 - 60.4），大多数患者为男性（54.8%）。既往合并症的中位数量为5（IQR：2 - 7）个诊断。直接出院回家的患者从2003年的28例（占所有幸存者的3.1%）增加到2014年的120例（12.5%）。在过去6年中，DDH的年均发生率在11%至12%之间。大约62%（n = 397）的患者等待病房床位的时间超过4小时，在DDH之前的中位延迟为2.0天（IQR：0.5 - 4.7）。ICU占用率与DDH率呈负相关（r = -0.55，P < 0.0001，95%置信区间[CI] = -0.36至 -0.69，R = 0.29）。与病房占用率和DDH率无相关性（r = -0.055，P = 0.64，95% CI = -0.25至0.21）。
在我们机构，DDH率随时间推移一直在增加，且与ICU床位占用率呈负相关，但与病房占用率无关。DDH患者年轻，入院时合并症少，出院诊断少，这些通常是疾病负担低的可逆单系统问题。在大多数情况下，转至病房会延迟，导致ICU住院时间增加，并且可能也会使总体住院时间增加。
