.jpg "Eric Sy, MD, MPH photo")
Eric Sy, MD, MPH
Intensivist
Regina General Hospital
Regina, Saskatchewan, Canada
Disclosure information not submitted.
Jonathan Mailman, BSc(Pharm) ACPR PharmD CD
Clinical Pharmacist Specialist
Regina General Hospital, United States
Disclosure information not submitted.
Sandy Kassir, MS MPH
Research Analyst
Saskatchewan Health Authority, United States
Disclosure information not submitted.
Chiraag Gupta, MD
Research Assistant
Regina General Hospital, United States
Disclosure information not submitted.
Zunaira Shahab, MD
Resident
University of Saskatchewan, United States
Disclosure information not submitted.
Nathan Fortin
Medical Student
University of Saskatchewan, United States
Disclosure information not submitted.
Vincent Lau, MD, MSc, FRCPC
Intensivist
University of Alberta, United States
Disclosure information not submitted.
Title: Risk Factors for Adverse Outcomes Following Direct Discharge Home From the Intensive Care Unit
Introduction: Recently, we observed an increase in 90-day hospital readmissions, for patients directly discharged home (DDH) from the intensive care unit (ICU) compared to ward transfer at our institution. The study objective was to identify risk factors for adverse outcomes following DDH from the ICU.
Methods: A retrospective observational cohort study was performed, including all patients who were DDH from ICU from Regina General Hospital (September 1, 2016-September 30, 2018). We defined an adverse outcome as the composite of either an emergency department (ED) visit, hospital readmission, and/or death. We identified 90-day and 365-day predictors using least absolute shrinkage and selection operator (LASSO) regression with 5-fold cross-validation.
Results: There were 1,337 ICU patients, of which, 148 (11.1%) were DDH from the ICU. Of these, 65 (43.9%) were female, the median age was 42 years (interquartile range [IQR], 28-58), admission sequential organ failure assessment (SOFA) score was 3 (1-6), Charlson comorbidity index (CCI) score 0 (0-2), ICU length of stay was 1.8 (1.0-2.9), 137 (92.6%) went home without supports, 6 (4.1%) required home supports, 2 (1.4%) were discharged to a facility, and 3 (2.0%) left against medical advice. The median time to any adverse outcome was 40 days (12-93). By 90 days, there were 60 (40.5%) patients with at least one ED visit, 45 (30.4%) with at least one hospital readmission, 5 (3.4%) deaths, and 62 (41.9%) patients with the composite event. By 365 days, there were 80 (54.1%), 60 (40.5%), 9 (6.1%), and 83 (56.1%), respectively. LASSO selected the following predictors for adverse outcomes for both 90 and 365 days: prior admission to ICU, higher CCI score, admission for renal failure, dialysis, or neurologic problems, and home residence in or within 50 km of Regina. However, increasing age, mechanical ventilation >96 hours, and admission for non-respiratory failure reasons were selected by LASSO at 365 days only. The area under the curve was 0.74 (95% confidence interval [CI] 0.66-0.82) and 0.81 (95% CI 0.74-0.88) for the 90- and 365-day models.
Conclusions: We identified several possible risk factors for adverse outcomes following DDH from the ICU. Further study of these factors in larger populations and targeted interventions may be warranted to improve the safety of DDH.