Discharge of dependent patients directly from the intensive care units after a critical illness: a single-center retrospective cohort study.

Abstract

This study aimed to determine the mortality and predictive factors affecting mortality of patients discharged directly from the intensive care unit (ICU) at the third- and sixth-month post-discharge. Additionally, it assessed the rate of hospital readmissions within 30 days post-discharge and the satisfaction level of family members with post-ICU care. In this single-center, retrospective, observational cohort study, dependent patients discharged directly from the ICU between July 1, 2019, and July 1, 2022, were included. Data on patients' demographics, reasons for admission, pre-existing diseases, length of ICU stay, advanced clinical interventions, discharge destination, physiological status on discharge, readmission within 30 days, and clinical outcomes and mortality at the third- and sixth-months post-discharge were collected. The study included 240 patients, representing 45.8% of all patients discharged directly from the ICU. Of these, 122 were discharged to their homes, and 118 to intermediate care units intermediate care units (IMCUs). The mean age was 71 years [interquartile range (IQR): 22.8]. Among the patients, 113 (47.1%) were readmitted within 30 days post-discharge, and 23 (20.35%) were re-hospitalized. The overall mortality rate in the third and sixth months was 25.4% and 32.5%, respectively. Logistic regression identified age, readmission within 30 days, and Glasgow Outcome Scale-Extended (GOS-E) at discharge as predictive factors for short-term and long-term mortality. Patients discharged to IMCUs had significantly higher long-term mortality. Family members of patients discharged to their homes had significantly higher satisfaction with post-ICU care (p=0.002). Discharging patients directly from the ICU to their homes may yield better outcomes in selected patients compared to discharging to IMCUs. This approach may also enable more efficient use of hospital resources and reduce ICU occupancy and associated costs.