Long-term Safety of Directly Discharging Patients Home from the ICU Compared to Ward Transfer

Abstract

Purpose: To evaluate the long-term safety of directly discharging intensive care unit (ICU) survivors to their home. Methods: A retrospective observational cohort of 341 ICU survivors who were directly discharged home from the ICU (“direct discharge”) or discharged home ≤72 hours after ICU transfer to the ward (“ward transfer”) was conducted in Regina, Saskatchewan ICUs between September 1, 2016 and September 30, 2018. The primary outcome was 90-day hospital readmission. Secondary outcomes included 30-day, 90-day, and 365-day emergency department (ED) visits, 30-day and 365-day hospital readmissions, and 365-day mortality. All outcomes were evaluated by multivariable Cox regression after adjustment for demographic and clinical characteristics. Results: Of 341 survivors (25.5% of total ICU visits), 148 (43.4%) patients were direct discharges and 193 (56.6%) were ward transfers. The median age was 46 years (interquartile range, 34-62), 38.4% were female, and 61.8% resided in Regina. Compared to the ward transfer cohort, more patients in the direct discharge cohort had at least one 90-day hospital readmission (30.4% versus 17.1% of patients, adjusted hazard ratio 2.09, 95% confidence interval 1.28-3.40, P = .003), after adjustment. Additionally, there were more 90-day ED visits ( P = .045), and 30-day ( P = .049) and 365-day hospital readmissions ( P = .03), after adjustment. Conclusions: In Saskatchewan, direct discharge compared to ward transfer was associated with an increase in 90-day hospital readmissions, and potentially other clinical outcomes. Further study is necessary.

Evaluating service needs for veno-venous extracorporeal membrane oxygenation in patients with severe acute respiratory distress syndrome in Saskatchewan

“…Thus, the estimated VV-ECMO volume at RGH could range from at least three to eleven cases of VV-ECMO per year. The estimated incidence of VV-ECMO use for ARDS would be 0.6 to 2.2 cases per 100,000 population per year (based on RGH’s catchment of approximately 500,000 residents) 11 . Statistics Canada forecasts a 14.3% to 43.8% growth in the population of Saskatchewan in the next 20 years 18 .…”

“…RGH is a tertiary care university-affiliated teaching hospital which can provide both VV- and veno-arterial (VA)-ECMO on an ad hoc basis. The hospital is a major referral centre in Southern Saskatchewan, serving about 500,000 residents in an area 11 over 100,000 km 2 . RGH has a standard ventilation protocol with most patients receiving pressure-regulated volume control as the initial set mode, with a set tidal volume of 6–8 mL/kg predicted body weight, while maintaining the peak inspiratory pressure (PIP) ≤ 35 cm H 2 O and plateau pressure ≤ 30 cm H 2 O. PEEP may be set by static compliance measurements and/or esophageal pressure manometry.…”