Stelfox HT, et al. - Researchers assessed intensive care unit (ICU) patients discharged directly home from the ICU vs those discharged home via the hospital ward, focusing on health care utilization and clinical outcomes. According to findings, the discharge of select adult patients directly home from the ICU was commonly seen and not related to greater health care utilization or higher mortality.

Methods

• This was a retrospective population-based cohort study.
• Participants were adult patients admitted to the ICU of 9 medical-surgical hospitals from January 1, 2014 to January 1, 2016, followed-up for 1-year following hospital discharge.
• All adult ICU patients were discharged home alive from hospital, and patient characteristics, therapies received in the ICU, and hospital characteristics were the basis for propensity score matched cohort (1:1).
• Readmission to the hospital within 30 days of hospital discharge was assessed as the primary outcome, while emergency department visit within 30 days and death within 1 year were evaluated as secondary outcomes.

Results

• This study included a total of 6,732 patients with median age 56 years (interquartile range, 41-67 years); of these, 2,826 (42%) were female.
• There were 922 patients who were discharged directly home (14%), with significant variation found between hospitals (range, 4.4%-44.0%).
• The patients who were younger (median age 47 vs 57 years; P < .001), more likely to be admitted with a diagnosis of overdose, substance withdrawal, seizures, or metabolic coma (32% [295] vs 10% [594]; P < .001), to have a lower severity of acute illness on ICU admission (median APACHE II score 15 vs 18; P < .001), and receive less than 48 hours of invasive mechanical ventilation (42% [389] vs 34% [1984]; P < .001) were discharged directly home, compared to patients discharged home via the hospital ward.
• In the propensity score matched cohort (n=1,632), similar length of ICU stays (median, 3.1 days vs 3.0 days; P=.42) but significantly shorter length of hospital stay (median, 3.3 days vs 9.2 days; P < .001) were observed among patients discharged directly home vs patients discharged home via the hospital ward.
• Patients discharged directly home or home via the hospital ward showed no remarkable differences in readmission to the hospital (10% [n=81] vs 11% [n=92]; hazard ratio [HR], 0.88; 95% CI, 0.64-1.20) or emergency department visit (25% [n=200] vs 26% [n=212]; HR, 0.94; 95% CI, 0.81-1.09) within 30 days of hospital discharge.
• In both groups, death of 4% of patients within 1 year of hospital discharge was reported (n=31 and n=34 in the discharged directly home and discharged home via the hospital ward groups, respectively) (HR, 0.90; 95% CI, 0.60-1.35).