ICU 患者直接出院的生存和安全结局-直接从 ICU 出院回家研究。
Survival and Safety Outcomes of ICU Patients Discharged Directly Home-A Direct From ICU Sent Home Study.
机构信息
Department of Medicine, Division of Critical Care, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
Department of Epidemiology and Biostatistics, Western University, London, ON, Canada.
出版信息
Crit Care Med. 2018 Jun;46(6):900-906. doi: 10.1097/CCM.0000000000003074.
OBJECTIVES
Evaluate outcomes (mortality, morbidity, unplanned return visits) of patients who are discharged directly to home from the ICU.
DESIGN
Prospective cohort study.
SETTING
Two tertiary care medical-surgical-trauma ICUs at Canadian hospitals over 1 year (February 2016-2017).
SUBJECTS
All adult patients who were either discharged directly to home (Recruited and Nonrecruited cohorts) from ICU or discharged home within 24 hours after ward transfer (Ward Transfer cohort).
INTERVENTIONS
Direct discharge home from ICU or discharge home within 24 hours of ward transfer from ICU.
MEASUREMENTS AND MAIN RESULTS
One-hundred ninety-eight patients were in the study, 100 patients in the discharged directly to home Recruited arm, 37 patients in the discharged directly to home Nonrecruited arm, and 61 patients in the Ward cohort. All three patient cohorts had 0% mortality at 8 weeks post discharge. The unplanned return visit rate for the Recruited cohort was 24% (emergency department 18%, Ward 4%, ICU 1%), whereas the rate for the Nonrecruited cohort was 52% (emergency department 34%, Ward 14%, ICU 3%) and the Ward Transfer cohort was 46% (emergency department 17%, Ward 26%, ICU 3%) (p = 0.005). No home support was available for 7% of the discharged directly to home Recruited cohort. Twenty-four percent of patients had funded home care nursing, but the majority of patients (81%) relied on help from friends/family.
CONCLUSIONS
Recruited discharged directly to home patients experienced very good 8-week postdischarge outcomes with 0% mortality and a low rate of ICU readmission (1%) or ward readmission (4%), but not an insignificant rate of emergency department visits (18%). Recruited discharged directly to home patients had better outcomes compared with nonrecruited discharged directly to home patients and patients transferred briefly to the ward prior to discharge home. Future work should include derivation of a clinical prediction tool to identify patient characteristics that make discharged directly to home safe and a randomized control trial to compare discharged directly to home with short stay ward transfers.
目的
评估从 ICU 直接出院回家的患者的结局（死亡率、发病率、非计划性复诊）。
设计
前瞻性队列研究。
设置
加拿大两家三级综合医院的 2 个内科-外科-创伤 ICU，为期 1 年（2016 年 2 月至 2017 年）。
受试者
所有从 ICU 直接出院回家（入组和未入组队列）或 ICU 病房转科后 24 小时内出院回家的成年患者。
干预措施
从 ICU 直接出院回家或 ICU 病房转科后 24 小时内出院回家。
测量和主要结果
研究纳入 198 例患者，入组直接出院回家组 100 例，未入组直接出院回家组 37 例，病房转科组 61 例。三组患者出院后 8 周的死亡率均为 0%。入组直接出院回家组的非计划性复诊率为 24%（急诊 18%、病房 4%、ICU 1%），而未入组直接出院回家组为 52%（急诊 34%、病房 14%、ICU 3%），病房转科组为 46%（急诊 17%、病房 26%、ICU 3%）（p = 0.005）。未入组直接出院回家组有 7%的患者没有家庭支持。24%的患者有资金支持家庭护理，但大多数患者（81%）依靠朋友/家人的帮助。
结论
入组直接出院回家的患者出院后 8 周的结局非常好，死亡率为 0%，ICU 再入院率（1%）或病房再入院率（4%）较低，但急诊就诊率（18%）并不低。与未入组直接出院回家的患者和在出院前短暂转科到病房的患者相比，入组直接出院回家的患者结局更好。未来的研究工作应包括开发一个临床预测工具，以确定使直接出院回家安全的患者特征，并进行一项随机对照试验，比较直接出院回家与短期留观病房转科。
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