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HOMEWARD BOUND FROM THE ICU

Memorial Sloan-Kettering Cancer Center, New York, NY

PURPOSE: Limited hospital bed availability may force the ICU to deliver post-ICU care until a patient is ready to be discharged home. The purpose of this study was to analyze the characteristics and outcome of this population.

METHODS: Using hospital databases, we retrospectively studied patients from November 1, 2004 to October 31, 2008 who were discharged home from the ICU. Data collected included age, gender, admitting service, Mortality Probability Model (MPM0) II score on ICU admission, ICU admission diagnosis, use of mechanical ventilation (MV) or vasopressors during ICU stay, lengths of stay (LOS), time from decision to discharge to actual discharge, day of discharge, DNR status, extent of disease and post-discharge 6 month mortality. Data are presented as mean (± SD), absolute numbers and percentages.

RESULTS: During the study period, 33 (1.4%) patients were discharged home with increasing frequency from year 2 to 4 (Table 1). The age was 61.2 (± 16.2) years, 61% were male, 72.7% (24/33) were medical and MPM0 II score was 39.9% (± 26.7%). Admitting diagnoses were typical of ICU patients (Table 2). MV was required on 12.1% (4/33) and vasopressors on 9.1% (3/33). ICU LOS was 4.1 (± 2.4) days and hospital LOS was 7.6 (± 12.7) days. The number of days from decision until actual discharge was 1.9 (± 1.5) days. Discharges predominated on Thursday-Saturday (73%; 24/33). Twenty (60.6%) patients had advanced malignancy (incurable or inoperable). Six-month mortality was 36.4% (12/33) and the average time to death was 53 days. Four patients were discharged with home hospice care, 3 were DNR and died within 4 days.

CONCLUSION: Although the number and percentage of ICU patients discharged home is small (1.4%), it has been recently increasing. While invasive support was minimal, the admitting diagnoses and severity of illness were typical of ICU patients. Further studies are needed to better define who could be discharged home.

CLINICAL IMPLICATIONS: If this trend continues there may be implications for ICU throughput, bed management and discharge planning.

DISCLOSURE: Ashraf Rashid, No Financial Disclosure Information; No Product/Research Disclosure Information