Patient, Family and Physician Satisfaction with Discharges Directly Home from Intensive Care Units – Direct from ICU Sent Home (DISH Study)
CCCF ePoster library. Lam J. 10/02/17; 198124; 19
Dr. Joyce Lam
Dr. Joyce Lam
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Patient, Family and Physician Satisfaction with Discharges Directly Home from Intensive Care Units - Direct from ICU Sent Home (DISH Study)

Lam, Joyce NH; Lau, Vincent I; Priestap, Fran A; Basmaji, John; 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.


Introduction: In the new era of decreasing hospital bed availability, there is an increasing rate of discharges directly to home (DDH) from intensive care units, despite sparse literature evaluating this practice. 
Objectives: To evaluate patient, family and ICU attending physician satisfaction with DDH from the intensive care unit (ICU); and intensivists’ current DDH practices and perceptions. 
Methods:  Prospective cohort study of adult patients undergoing DDH from an intensive care unit between February 2016 and February 2017, using a modified FS-ICU 24 ICU satisfaction survey completed by patients, family members, and attending physicians at the time of patient discharge home from the ICU. 
Results:   A majority of patients (89%) and families (78%) were satisfied or very satisfied with DDH. Only 6% of patients and 8% of families were dissatisfied to very dissatisfied with DDH. Conversely, ICU physician satisfaction varied, with only 5% very comfortable with DDH and the majority (50%) only somewhat comfortable. 20% of staff consultants were uncomfortable to very comfortable with the practice of DDH   31% of staff physician respondents felt patient and family discomfort would be barriers to DDH. Compared to physicians and other allied health professionals, nurses were identified as the most helpful members of the health care team in preparation for DDH by 98% of patients and 92% of family members. The estimated annual number of DDH patients per ICU physician varied widely (2-30) with a median of 5 patients per year. DDH rates have increased for the past twelve years in our ICUs, but declined during the study period (February 2016 - 2017).
Conclusions: Patients and family members are satisfied with the practice of direct discharge to home from ICU, although ICU physician satisfaction is more variable.  Physician comfort may be improved by data informing which patients may be safely discharged directly home from the ICU.

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