Select adult patients can be safely discharged directly home from an ICU

Reference

Stelfox HT, Soo A, Niven DJ, et al. Assessment of the safety of discharging select patients directly home from the intensive care unit. JAMA Intern Med 2018;178(10):1390-1399.

Synopsis

For this study, 6732 adults discharged from 9 Canadian medical-surgical ICUs were included in the cohort. The exposed group was defined as patients who were discharged directly from the ICU to home (n = 922); the nonexposed group included patients who were transferred from the ICU to a hospital ward before discharge to home (n = 5810). Patients in the exposed group were younger, had fewer comorbidities, and were less likely to have received mechanical ventilation or vasopressors during their ICU stay. The most common diagnoses for these patients were overdose, withdrawal, seizures, or metabolic coma. Using propensity score matching, 816 patients in the exposed group were matched to 816 patients in the unexposed group. In this matched cohort, patients discharged directly home had similar lengths of ICU stay (approximately 3 days) but shorter lengths of hospital stay (3.3 days vs 9.2 days; P < .001) than those discharged via hospital ward. For the primary outcome of 30-day readmission rate, there was no significant difference detected between the 2 groups (10% for direct discharge to home vs 11% for discharge home via hospital ward). Similarly, there were no differences in the rate of ED visits within 30 days (25% vs 26%) or the rate of mortality at one year (4% for both groups). For patients discharged directly home, independent risk factors associated with readmission or ED visits within 30 days included leaving against medical advice, being discharged with community support services, and being discharged from an ICU that discharged 1 or more patients directly home per week.