title: Waiting for the break of dawn? The effects of discharge time, discharge TISS scores and discharge facility on hospital mortality after intensive care.
abstract: OBJECTIVE
  To assess the effects of discharge Therapeutic Intervention Scoring System (TISS) scores, discharge time and type of discharge facility on ultimate hospital mortality after intensive care.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  General intensive care unit (ICU) in a district general hospital.
  
  
  METHODS
  One thousand six hundred fifty-four ICU patients discharged to hospital wards or high dependency units (HDUs).
  
  
  RESULTS
  Vital status at ultimate hospital discharge was the main outcome measurement. The crude hospital mortality after ICU discharge (12.6%) was significantly associated with increasing discharge TISS scores (chi(2) for trend =9.0, p=0.028). This trend was similarly observed after adjusting for severity of disease. Patients with high TISS scores (>30) who were discharged to hospital wards had a higher risk (1.31; CI: 1.02-1.83) of in-hospital death compared with patients discharged to HDUs. Crude mortality was significantly higher for late 20.00 h to 7.59 h) than for early (8.00 h to 19.59 h) discharges (18.8% versus 11.2%, chi(2) =12.1, p=0.0004). Adjusted for disease severity, the mortality risk was 1.70-fold (CI: 1.28-2.25) increased for late ICU discharges. Patients discharged late to hospital wards had significantly higher severity-adjusted risks (1.87; CI:1.36-2.56) than had patients discharged to HDUs (1.35; CI: 0.77-2.36).
  
  
  CONCLUSIONS
  Both late discharge and high discharge TISS scores are indicators of "premature" ICU discharge and were associated with increased mortality. Intermediate care reduced the mortality of patients discharged "prematurely" from ICU. This adds to the growing evidence of the benefits of intermediate care after ICU discharge.
authors.affiliation: Department of Anaesthesiology and Intensive Care, Charité Hospital, Humboldt University, Schumannstr. 20-21, 10098 Berlin, Germany. dieter.beck@rz.hu-berlin.de
authors.forename: Dieter H
authors.initials: DH
authors.lastname: Beck
authors.forename: Peter
authors.initials: P
authors.lastname: McQuillan
authors.forename: Gary B
authors.initials: GB
authors.lastname: Smith
mesh_terms: D015331:Cohort Studies; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006767:Hospitals, District; D006769:Hospitals, General; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010360:Patient Transfer / Q000706:statistics & numerical data*; D011383:Progressive Patient Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors