Factors Associated with the Increasing Rates of Discharges Directly Home From Intensive Care Units - Direct from ICU Sent Home (DISH Study)
CCCF ePoster library. Lau V. 11/01/16; 150927; 48
Dr. Vincent Lau
Dr. Vincent Lau
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Topic: Retrospective or Prospective Cohort Study

Factors Associated with the Increasing Rates of Discharges Directly Home From Intensive Care Units – Direct from ICU Sent Home (DISH Study)

Lau, Vincent1; Priestap, Fran1, Lam Joyce1, Ball, Ian1
1Department of Medicine, Division of Critical Care, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.


Objectives: 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.

Methods:     Retrospective cohort study of all adult patients who survived their stay in our medical-surgical-trauma intensive care unit between April 2003 and March 2015.

Results: Median age was 49 years (IQR 33.5-60.4), and the majority of the patients were male (54.8%). Median number of pre-existing co-morbidities was 5 (IQR 2-7) diagnoses. The median number of discharge diagnoses was 1 (IQR 1-2).  DDH increased from 28 patients (3.1% of all survivors) in 2003 to 120 patients (12.5%) in 2014.  The mean annual rate of DDH was between 11-12% over the last 6 years. Approximately 62% of patients (n = 397) waited longer than 4 hours for a ward bed, with a median delay of 2.0 days (IQR 0.5-4.7) before being discharged directly home. There was an inverse correlation between ICU occupancy and DDH rates (rP = -0.55 (p <0.0001, 95% CI = -0.36 to -0.69, R2 = 0.29)). There was no correlation with ward occupancy and DDH rates (rs = -0.055, (p = 0.64, 95% CI = -0.25 to 0.21)).

Conclusions:  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. DDH patients are young, have few co-morbidities 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 length of stay and likely increased overall hospital length of stay as well. 

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