title: Factors Associated With the Increasing Rates of Discharges Directly Home From Intensive Care Units-A Direct From ICU Sent Home Study.
abstract: OBJECTIVE
  To evaluate the relationship between rates of discharge directly to home (DDH) from the intensive care unit (ICU) and bed availability (ward and ICU). Also to identify patient characteristics that make them candidates for safe DDH and describe transfer delay impact on length of stay (LOS).
  
  
  METHODS
  Retrospective cohort study of all adult patients who survived their stay in our medical-surgical-trauma ICU between April 2003 and March 2015.
  
  
  RESULTS
  Median age was 49 years (interquartile range [IQR]: 33.5-60.4), and the majority of the patients were males (54.8%). Median number of preexisting comorbidities was 5 (IQR: 2-7) diagnoses. Discharge directly to home increased from 28 (3.1% of all survivors) patients in 2003 to 120 (12.5%) patients in 2014. The mean annual rate of DDH was between 11% and 12% over the last 6 years. Approximately 62% (n = 397) of patients waited longer than 4 hours for a ward bed, with a median delay of 2.0 days (IQR: 0.5-4.7) before being DDH. There was an inverse correlation between ICU occupancy and DDH rates ( rP= -.55, P < .0001, 95% confidence interval [CI] = -0.36 to -0.69, R2= .29). There was no correlation with ward occupancy and DDH rates ( rs= -.055, P = .64, 95% CI = -0.25 to 0.21).
  
  
  CONCLUSIONS
  The DDH rates have been increasing over time at our institution and were inversely correlated with ICU bed occupancy but were not associated with ward occupancy. The DDH patients are young, have few comorbidities on admission, and few discharge diagnoses, which are usually reversible single system problems with low disease burden. Transfers to the ward are delayed in a majority of cases, leading to increased ICU LOS and likely increased overall hospital LOS as well.
authors.affiliation: 1 Division of Critical Care, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
authors.forename: Vincent I
authors.initials: VI
authors.lastname: Lau
authors.affiliation: 1 Division of Critical Care, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
authors.forename: Fran A
authors.initials: FA
authors.lastname: Priestap
authors.affiliation: 1 Division of Critical Care, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
authors.forename: Joyce N H
authors.initials: JNH
authors.lastname: Lam
authors.affiliation: 1 Division of Critical Care, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.|2 Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada.
authors.forename: Ian M
authors.initials: IM
authors.lastname: Ball
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001509:Bed Occupancy; D015331:Cohort Studies; D015897:Comorbidity; D016638:Critical Illness / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009864:Ontario; D010351:Patient Discharge / Q000706:statistics & numerical data* / Q000639:trends; D010362:Patients' Rooms; D012189:Retrospective Studies; D012720:Severity of Illness Index
keywords: demographics; discharge; home; intensive care unit; length of stay; occupancy