Stelfox HT, et al. - In this retrospective population-based cohort study, researchers investigated the health-care utilization and clinical outcomes for adult patients discharged directly home from the intensive care unit (ICU) vs those discharged home via the hospital ward in this multicenter population-based cohort study. Findings suggested that select adult patients were commonly discharged directly home from the ICU, with no evident association of increased health-care utilization or mortality.

Methods

• Researchers included adult patients admitted to the ICU of nine medical-surgical hospitals from January 1, 2014, to January 1, 2016, with 1-year follow-up after hospital discharge.
• All adult ICU patients discharged home from hospital were alive.
• Patient characteristics, therapies received in the ICU, and hospital characteristics underlie the propensity score matched cohort (1:1).
• Readmission to the hospital within 30 days of hospital discharge was assessed as the primary outcome.
• Emergency Department visit within 30 days and death within 1 year comprised the secondary outcomes.

Results

• Researchers included 6,732 patients in the study, of whom 2,826 (42%) were female; median age was 56 years (interquartile range, 41-67 years).
• Discharge directly home was noted for 922 (14%) patients, which varied significantly between hospitals (range, 4.4% to 44.0%).
• Compared with patients discharged home via the hospital ward, those discharged directly home were found to be: younger (median age 47 vs 57 years; P < 0 .001); more frequently admitted with a diagnosis of overdose, substance withdrawal, seizures, or metabolic coma (32% [295] vs 10% [594]; P < 0.001); with a lower severity of acute illness on ICU admission (median APACHE II score 15 vs 18; P < 0.001); and in receipt of < 48 hours of invasive mechanical ventilation (42% [389] vs 34% [1,984]; P < 0.001).
• For patients discharged directly home vs patients discharged home via the hospital ward, they noted similar length of ICU stay (median, 3.1 days vs 3.0 days; P=0.42) but significantly shorter length of hospital stay (median, 3.3 days vs 9.2 days; P <0.001) in the propensity score matched cohort (n=1,632).
• Patients discharged directly home or home via the hospital ward were not significantly different regarding 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, 4% of patients died within 1 year of hospital discharge (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).