Critical care delayed discharge: Good or bad?

Abstract

NHS England is to introduce a new Commissioning for Quality and Innovation to reduce delayed discharges from adult critical care to ward-level care. A delayed discharge is greater than 4 h, this occurred in 64.2% of patients in the critical care minimum data set database from Intensive Care National Audit & Research Centre from the last five years; 46.3% were delayed between 4 and 24 h and 17.9% were delayed more than 24 h. For those who had a delay in their discharge of greater than 24 h, the data suggests that ''sicker'' patients ultimately do better, since there was a reduction in expected mortality of 5892 patients to an actual mortality of 5201 patients over the five years. More in depth analysis of this data is necessary to try to identify which patients are more likely to benefit from extending their critical care stay once the need for organ support has abated. The current Commissioning for Quality and Innovation offers a slightly perverse incentive against this cohort of patients.

How does the implementation of a patient pathway-based intervention in the acute care of blunt thoracic injury impact on patient outcomes? A systematic review of the literature

“…Similarly, the impact of extended ICU LoS has been well documented in the literature [39] , [40] , [41] and the variables that impact on ICU LoS is multi-faceted and complex [42] , [43] , [44] . Despite these data, it is important to remember that ICU LoS is confounded by delayed discharge, and this is often due to lack of acute care beds where patients should be discharged within four hours of a decision to discharge [ 45 , 46 ]. Similarly, in the US, this measure is confounded by long-term care facility bed provision [ 47 ].…”