title: Antipsychotic utilization in the intensive care unit and in transitions of care.
abstract: The objective of this study was to quantify the rate at which newly initiated antipsychotic therapy is continued on discharge from the intensive care unit (ICU) and describe risk factors for continuation post-ICU discharge.
  
  
  
  This is a retrospective cohort study of all patients receiving an antipsychotic in the ICUs of a large academic medical center from January 1, 2005, to October 31, 2011. Medical record review was conducted to ascertain whether a patient was newly started on antipsychotic therapy and whether therapy was continued post-ICU discharge.
  
  
  
  A total of 39,248 ICU admissions over the 7-year period were evaluated. Of these, 4468 (11%) were exposed to antipsychotic therapy, of which 3119 (8%) were newly initiated. In the newly initiated cohort, 642 (21%) were continued on therapy on discharge from the hospital. Type of drug (use of quetiapine vs no use of quetiapine: odds ratio, 3.2; 95% confidence interval, 2.5-4.0; P < .0001 and use of olanzapine: odds ratio, 2.4, 95% confidence interval, 2.0-3.1; P ≤ .0001) was a significant risk factor for continuing antipsychotics on discharge despite adjustment for clinical factors.
  
  
  
  Antipsychotic use is common in the ICU setting, and a significant number of newly initiated patients have therapy continued upon discharge from the hospital.
authors.affiliation: Department of Pharmacy, Beth Israel Deaconess Medical Center. Electronic address: jmarshal@bidmc.harvard.edu.
authors.forename: John
authors.initials: J
authors.lastname: Marshall
authors.affiliation: Department of Medicine, Beth Israel Deaconess Medical Center.
authors.forename: Shoshana J
authors.initials: SJ
authors.lastname: Herzig
authors.affiliation: Department of Medicine, Division of Pulmonary/Critical Care University of Chicago.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Howell
authors.affiliation: Department of Pharmacy Mount Auburn Hospital.
authors.forename: Stephen H
authors.initials: SH
authors.lastname: Le
authors.affiliation: Department of Pharmacy Maimonides Medical Center.
authors.forename: Chris
authors.initials: C
authors.lastname: Mathew
authors.affiliation: Department of Pharmacy, Beth Israel Deaconess Medical Center.
authors.forename: Julia S
authors.initials: JS
authors.lastname: Kats
authors.affiliation: Instructor of Medicine Harvard Medical School, Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center.
authors.forename: Jennifer P
authors.initials: JP
authors.lastname: Stevens
mesh_terms: D000368:Aged; D014150:Antipsychotic Agents / Q000600:supply & distribution / Q000627:therapeutic use*; D015331:Cohort Studies; D003266:Continuity of Patient Care; D003663:Decision Trees; D003693:Delirium / Q000188:drug therapy / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D008875:Middle Aged; D016017:Odds Ratio; D010351:Patient Discharge; D000069348:Quetiapine Fumarate; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D014150:Antipsychotic Agents; D000069348:Quetiapine Fumarate
keywords: Antipsychotic agents; Delirium; Medication reconciliation
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