title: Survivors of catastrophic illness: outcome after direct transfer from intensive care to extended care facilities.
abstract: OBJECTIVE
  To describe outcomes of adult survivors of prolonged critical illness after direct transfer to extended care facilities.
  
  
  METHODS
  A retrospective cohort study.
  
  
  METHODS
  All adult intensive care units (ICUs) in a tertiary care university hospital.
  
  
  METHODS
  A consecutive series of 97 adult survivors with an ICU stay of > or =7 days transferred directly from intensive care to extended care facilities between 1990 and 1996.
  
  
  METHODS
  None.
  
  
  RESULTS
  Hospital and extended care facility charts were reviewed for patient characteristics, resource utilization, and survival. Survivors were for a minimum of 1 yr and a maximum of 6 yrs, and were interviewed to assess quality of life and functionality. The mean age of the patients was 66+/-16 (range, 19-93) yrs. The median length of ICU stay for these patients was 39 (range, 7-276) days. Only 18 of the 71 ventilator-assisted patients were weaned from mechanical ventilation after transfer to the extended care facility. Survival for the study period, at 1 yr after discharge from the ICU, was 49.5%. One year after discharge from the ICU, 11.5% of all patients had returned home, were breathing spontaneously, had a fair or better quality of life, and had good physical functionality. Each successive year, an increasing proportion of patients underwent direct transfer to an extended care facility. This strategy decreased the patients' length of stay (p<.002) in the ICU from year to year, but was significantly associated with an increase in readmissions to acute care hospitals (p<.002).
  
  
  CONCLUSIONS
  Survivors of catastrophic illness who are so debilitated that they require transfer to an extended care facility have a low likelihood of achieving both survival and functional independence 1 yr after discharge from the ICU. Aggressive cost-conscious strategies to accelerate the transfer of these patients successfully reduced the length of ICU stay and hospital costs, but were associated with a high rate of readmission to tertiary care facilities.
authors.affiliation: Department of Surgery, Tufts-New England Medical Center, Boston, MA 02111, USA. Snasraway@lifespan.org
authors.forename: S A
authors.initials: SA
authors.lastname: Nasraway
authors.forename: G J
authors.initials: GJ
authors.lastname: Button
authors.forename: W M
authors.initials: WM
authors.lastname: Rand
authors.forename: T
authors.initials: T
authors.lastname: Hudson-Jinks
authors.forename: M
authors.initials: M
authors.lastname: Gustafson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001900:Boston / Q000453:epidemiology; D015331:Cohort Studies; D016638:Critical Illness / Q000401:mortality* / Q000534:rehabilitation*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010360:Patient Transfer; D011788:Quality of Life; D012189:Retrospective Studies; D012866:Skilled Nursing Facilities; D016019:Survival Analysis; D017741:Survivors