Intensive care discharge delay is associated with increased hospital length of stay: A multicentre prospective observational study.

Ravindranath Tiruvoipati,Jason Fletcher,David Pilcher,Sanjiv Vij,Mainak Majumdar,John Botha,Himangsu Gangopadhyay,Eldho Paul,Chiara Lazzeri

doi:10.1371/journal.pone.0181827

Abstract

BackgroundSome patients experience a delayed discharge from the intensive care unit (ICU) where the intended and actual discharge times do not coincide. The clinical implications of this remain unclear.ObjectiveTo determine the incidence and duration of delayed ICU discharge, identify the reasons for delay and evaluate the clinical consequences.MethodsProspective multi-centre observational study involving five ICUs over a 3-month period. Delay in discharge was defined as >6 hours from the planned discharge time. The primary outcome measure was hospital length stay after ICU discharge decision. Secondary outcome measures included ICU discharge after-hours, incidence of delirium, survival to hospital discharge, discharge destination, the incidence of ICU acquired infections, revocation of ICU discharge decision, unplanned readmissions to ICU within 72 hours, review of patients admitting team after ICU discharge decision.ResultsA total of 955 out of 1118 patients discharged were included in analysis. 49.9% of the patients discharge was delayed. The most common reason (74%) for delay in discharge was non-availability of ward bed. The median duration of the delay was 24 hours. On univariable analysis, the duration of hospital stay from the time of ICU discharge decision was significantly higher in patients who had ICU discharge delay (Median days-5 vs 6; p = 0.003). After-hours discharge was higher in patients whose discharge was delayed (34% Vs 10%; p<0.001). There was no statistically significant difference in the other secondary outcomes analysed. Multivariable analysis adjusting for known confounders revealed delayed ICU discharge was independently associated with increased hospital length of stay.ConclusionHalf of all ICU patients experienced a delay in ICU discharge. Delayed discharge was associated with increased hospital length of stay.

Highlights

Discharge from intensive care unit (ICU) is usually planned when patients have recovered from critical illness or when the intensive care physician believes that further intensive care treatment is no longer in the patients best interest
Our study showed that patients who were discharged with a delay of more than 6 hours had a longer length of hospital stay and more patients were discharged after hours
Our study demonstrated that the incidence of delirium was higher in patients whose ICU discharge was delayed by more than 24 hours

Summary

Introduction

Discharge from intensive care unit (ICU) is usually planned when patients have recovered from critical illness or when the intensive care physician believes that further intensive care treatment is no longer in the patients best interest. The duration of stay in intensive care depends on the severity of the presenting problem and the pre-morbid physiological reserve of the patient. It is known from the published literature that admission and discharge of patients from intensive care units during ‘after-hour’ periods is associated with an increased mortality and morbidity[1,2,3]. It is essential that patients are discharged in a timely manner to facilitate their ongoing care and hospital discharge planning. Some patients experience a delayed discharge from the intensive care unit (ICU) where the intended and actual discharge times do not coincide.

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Results

Conclusion