Intensive care discharge delay is associated with increased hospital length of stay: A multicentre prospective observational study

Abstract

BackgroundSome patients experience a delayed discharge from the intensive care unit (ICU) where the intended and actual discharge times do not coincide. The clinical implications of this remain unclear.ObjectiveTo determine the incidence and duration of delayed ICU discharge, identify the reasons for delay and evaluate the clinical consequences.MethodsProspective multi-centre observational study involving five ICUs over a 3-month period. Delay in discharge was defined as >6 hours from the planned discharge time. The primary outcome measure was hospital length stay after ICU discharge decision. Secondary outcome measures included ICU discharge after-hours, incidence of delirium, survival to hospital discharge, discharge destination, the incidence of ICU acquired infections, revocation of ICU discharge decision, unplanned readmissions to ICU within 72 hours, review of patients admitting team after ICU discharge decision.ResultsA total of 955 out of 1118 patients discharged were included in analysis. 49.9% of the patients discharge was delayed. The most common reason (74%) for delay in discharge was non-availability of ward bed. The median duration of the delay was 24 hours. On univariable analysis, the duration of hospital stay from the time of ICU discharge decision was significantly higher in patients who had ICU discharge delay (Median days-5 vs 6; p = 0.003). After-hours discharge was higher in patients whose discharge was delayed (34% Vs 10%; p<0.001). There was no statistically significant difference in the other secondary outcomes analysed. Multivariable analysis adjusting for known confounders revealed delayed ICU discharge was independently associated with increased hospital length of stay.ConclusionHalf of all ICU patients experienced a delay in ICU discharge. Delayed discharge was associated with increased hospital length of stay.

Transition of care at discharge from the Intensive Care Unit: a scoping review

“…Readmission affects 4.1% ( 51 ) to 9.2% ( 46 ) of the patients in any period of hospitalization, 2.9% ( 14 ) in 48 hours after the transfer and 2.7% ( 32 ) to 4.2% ( 13 ) within 72 hours. Other clinical outcomes analyzed are length of hospital stay ( 31 - 32 , 35 , 39 - 40 , 49 ) , care provided by a Rapid Response Team (RRT) ( 26 , 43 ) , cardiac arrest ( 47 ) , and medications-related problems ( 49 ) . Outcomes such as anxiety, stress, and satisfaction of patients and families also appear in the studies ( 24 , 28 , 30 , 44 , 48 ) .…”

“…Some studies verify the association of certain practices with readmission and mortality rates, such as discharges at nights or weekends ( 19 , 32 , 34 - 35 ) . Discharges with delays of more than 24 hours showed a significant association with a higher incidence of delirium ( 40 ) . Medication reconciliation or pharmaceutical intervention by reviewing medications prior to patient transfer may contribute to a decrease in the number and severity of medication-related problems; however, the impact on the mortality rate, length of hospital stay or ICU readmission is still inconclusive ( 49 ) .…”

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 ].…”

Association Between Intensive Care Unit Occupancy at Discharge, Afterhours Discharges, &amp; Clinical Outcomes: An Historical Cohort Study

“…Delayed discharge was defined as a delay of 6 or more hours between the time a patient was labelled appropriate for discharge and when patient physically left the ICU. This definition of delayed discharge has been utilized in a previous analysis (20) while other studies have used either…”