NEW YORK (Reuters Health) - Discharge directly to home from a critical care unit can be just as safe as discharge within 48 hours of transfer to a hospital ward, a large study suggests.
Dr. Claudio Martin of Western University in London, Ontario and colleagues reviewed data on adults discharged from 157 intensive care units in 100 area hospitals between April 2015 and March 2017. Overall, 76,737 patients were discharged either directly from the ICU or within 48 hours of transfer to the ward, including 46,859 who were DDH.
All ICUs discharged patients directly to home during the study period, according to a report published in Critical Care Medicine. In the 95 medical and surgical ICUs, 18,260 of 33,122 patients (55%) were DDH; in the 27 coronary units and 35 step-down units, 28,599 of 43,615 patients (66%) were DDH.
Comparing propensity-matched cohorts of 23,764 patients discharged directly to home (DDH) and 23,764 patients who were first transferred to wards, the researchers saw similar 30 day rates of hospital readmissions or emergency department visits: 9.7% in the DDH group vs 9.6% in controls.
Patients were matched based on factors such as age, gender, need for dialysis, blood transfusion, mechanical and noninvasive ventilation as well as other complications of chronic disease such as diabetes, COPD, and congestive heart failure.
There was no significant difference in the primary outcome of hospital readmission or emergency department visit within 30 days, both in the overall study population and when patients were stratified according to whether they had been in a level 2 or level 3 ICU.
There was also no difference in 90 day mortality between patients discharged to the ward or DDH, but mortality at 90 days was higher for patients who were DDH from a level 3 ICU (3.6%, vs 2.9% for patients discharged from the ward (OR 1.24,95% CI 1.04-1.44).
Results were similar in an instrumental variable (IV) analysis, except the IV analysis did not show a difference in mortality rate depending on ICU level.
The median total hospital length of stay was 2 days (IQR 1-4 days) in the DDH group compared to 3 days in patients discharged from the ward (IQR ¬2-5 days).
The authors note that the largest predictor of DDH was practice variation and that a limitation of the study was their inability to evaluate how patients were selected for DDH. However, they believe that standardizing the use of DDH "could improve system efficiency by eliminating at least one transition of care and potentially reducing ICU and hospital duration for of stay for select patients."
SOURCE: https://bit.ly/3uXUxyk Critical Care Medicine, online March 14, 2022.
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