Days Of Discharge In Patients Research Articles

Improving the Accuracy of Patient Self-Care After Joint Replacement Surgery

Joint replacement wound stitches are typically not removed until two weeks after the operation. Therefore, patients with joint replacement must be able to execute proper wound care after discharge from the hospital to reduce the risk of wound infection. Prior data from Chang Gung Memorial Hospital's orthopedics ward indicate only 69% of joint-replacement patients are able to perform wound care properly at home. Potential causes for this noted by patients include age-related forgetfulness, being unable to discern redness or swelling in the wound, and language comprehension difficulties (i.e., Taiwanese vs. Mandarin). Poor rates of wound care may also be attributable to incomplete wound care education by nursing staff and wound care education being provided without adequate practice on the day of patient discharge. This project was implemented to improve the accuracy of wound self-care performed by patients after joint replacement surgery and to enhance their related knowledge and wound-care technical correctness. A wound care education checklist, wound care cue cards, wound care video clips, wound condition red flag cue cards, and customized wound care pack were proposed and implemented. The rate of accuracy of wound self-care performance increased from 69% pretest to 98% posttest, showing the intervention to have effectively improved post-discharge wound care quality. To effectively improve the post-discharge accuracy of wound self-care in patients with joint replacement, the consistency of post-surgery wound care education given by nursing staff to patients should be improved, patients should be reminded of wound assessment and care steps, and patients should be aware that wound abnormalities require an immediate return to the hospital for follow-up treatment.

466 Development of Machine Learning Algorithms to Predict Symptomatic VTE at Time of Admission and Time of Discharge after Severe Traumatic Injury

OBJECTIVES/GOALS: Clinical indicators predictive of venous thromboembolism (VTE) in trauma patients at multiple time points are not well outlined, particularly at time of discharge. We aimed to describe and predict inpatient and post-discharge risk factors of VTE after trauma using a multi-variate regression model and best of class machine learning (ML) models. METHODS/STUDY POPULATION: In a prospective, case-cohort study, all trauma patients (pts) who arrived as level 1 or 2 trauma activations, from June 2018 to February 2020 were considered for study inclusion. A subset of pts who developed incident, first time, VTE and those who did not develop VTE within 90 days of discharge were identified. VTE were confirmed either by imaging or at autopsy during inpatient stay or post-discharge. Outcomes were defined as the development of symptomatic VTE (DVT and/or PE) within 90 days of discharge.A multi-variate Cox regression model and a best in class of a set of 5 different ML models (support-vector machine, random-forest, naives Bayes, logistic regression, neural network]) were used to predict VTE using models applied a) at 24 hours of injury date or b) on day of patient discharge. RESULTS/ANTICIPATED RESULTS: Among 393 trauma pts (ISS=12.0, hospital LOS=4.0 days, age=48 years, 71% male, 96% with blunt mechanism, mortality 2.8%), 36 developed inpatient VTE and 36 developed VTE after discharge. In a weighted, multivariate Cox model, any type of surgery by day 1, increased age per 10 years, and BMI per 5 points were predictors of overall symptomatic VTE (C-stat 0.738). Prophylactic IVC filter placement (4.40), increased patient age per 10 years, and BMI per 5 points were predictors of post-discharge symptomatic VTE (C-stat= 0.698). A neural network ML model predicted VTE by day 1 with accuracy and AUC of 0.82 and 0.76, with performance exceeding those of a Cox model. A naīve Bayesian ML model predicted VTE at discharge, with accuracy and AUC of 0.81 and 0.77 at time of discharge, with performance exceeding those of a Cox model. DISCUSSION/SIGNIFICANCE: The rate of inpatient and post-discharge VTEs remain high. Limitations: single institution study, limited number of patients, internal validation only, with the use of limited number of ML models. We developed and internally validated a ML based tool.Future work will focus on external validation and expansion of ML techniques.

Incidence, causes, and risk factors for unplanned readmission in patients admitted with pulmonary tuberculosis in China.

To investigate the incidence, causes, and risk factors for unplanned readmission within 30 days of discharge in patients with pulmonary tuberculosis (TB). The clinical data of 1,062 patients with confirmed pulmonary TB who were admitted to our hospital from October 2018 to October 2021 were analysed retrospectively. The subjects were divided into a readmission group (354 cases) and a non-readmission group (708 cases) according to whether there was an unplanned admission within 30 days of discharge. We analysed the risk factors for unplanned readmission within 30 days after discharge with pulmonary TB. The incidence of unplanned readmission in patients with pulmonary TB was 5.2%. Being female (OR = 0.63, 95% CI: 0.434-0.942) and living in cities (OR = 0.218, 95% CI: 0.151-0.315) were protective factors for the readmission of patients with TB (p < 0.05). However, being ≥ 65 years old (OR = 2.574, 95% CI: 1.709-3.870), being a smoker (OR = 2.773, 95% CI: 1.751-4.390), having chronic obstructive pulmonary disease (COPD) (OR = 3.373, 95% CI: 1.708-6.660), having viral hepatitis (OR= 2.079, 95% CI: 1.067-4.052), receiving non-standard treatment (OR = 15.620, 95% CI: 10.413-23.431), having medical side effects (OR = 6.138, 95% CI: 3.798-9.922) and l unauthorised discharge (OR = 2.570, 95% CI: 1.509-4.376) were risk factors for the readmission to hospital of patients with TB (p < 0.05). Gender, age, place of residence, smoking, COPD, hepatitis, non-standard treatment, adverse drug reactions and unauthorised discharge were risk factors of TB for unplanned readmission.

Factors associated with readmission to the same hospital within 30 days of discharge in patients who received surgical treatment for head and neck cancer: An NCDB analysis.

e18570 Background: Readmission rates within 30-days of discharge is an important quality metric when caring for hospitalized patients. Higher rates of readmission are a predictor of all-cause mortality and associated with negative financial implications for hospitals. Patients undergoing surgery for the treatment of head and neck cancer have readmission rates ranging from 7.3% to 26.5%. The benefits to the patient and the hospital highlight the importance of determining if certain patient features impact the likelihood of readmission. This study sought to determine if certain socioeconomic and demographic factors are associated with higher 30-day readmission rates following surgically treated head and neck cancers. Methods: Using the National Cancer Database, 221,822 patients were identified as having surgically treated head and neck cancer between 2004 and 2020. Using SPSS statistics 28, 30-day readmission rates for these patients were compared to each other based on certain characteristics including sex, race, ethnicity, insurance status, income, and facility type. Results were analyzed using descriptive statistics, a multivariate binary logistic regression, and chi-square analyses using a significance level of p &lt; 0.05. Results: Higher 30-day readmission rates in patients with certain demographic and socioeconomic factors were identified. Black and Asian patients had higher readmission rates in comparison to white patients (p &lt; .001, 95% CI = 1.24-1.41 and 1.08-1.30, respectively). Patients of Hispanic backgrounds were 25% more likely to be readmitted than non-Hispanic patients (p &lt; .001, 95% CI = 1.15-1.34). Males had a 13% higher readmission rate than females (p &lt; .001, 95% CI = 1.09-1.17). Uninsured patients were more likely to be readmitted than those with some form of insurance (p &lt; .001). Those with a median annual income less than $46,277 were 11% more likely to be readmitted than those who had a median annual income higher than $46,277 (p &lt; .001). In comparison to those treated at a community cancer program, patients who received treatment at academic/research programs or integrated network cancer programs were 32% and 21% more likely to be readmitted, respectively (p &lt; .001, 95% CI = 1.20-1.45 and 1.10-1.34, respectively). Conclusions: Patients who are more likely to be readmitted to the same hospital within 30-days of being surgically treated for head and neck cancers include black patients, Asians, those of Hispanic descent, males, the uninsured, those with a lower median annual income, and those who received surgical treatment at academic/research programs or integrated network cancer programs. Identification of factors contributing to readmission allows for development of targeted interventions to prevent this occurrence.

Ambient temperature and atmospheric pressure at discharge as precipitating factors in immediate adverse events in patients treated for decompensated heart failure.

To investigate the relationship of ambient temperature and atmospheric pressure (AP) at patient discharge after an episode of acute heart failure (AHF) with very early post-discharge adverse outcomes. We analyzed 14,656 patients discharged after an AHF episode from 26 hospitals in 16 Spanish cities. The primary outcome was the 7-day post-discharge combined adverse event (emergency department -ED- revisit or hospitalization due to AHF, or all-cause death), and secondary outcomes were these three adverse events considered individually. Associations (adjusted for patient and demographic conditions, and length of stay -LOS- during the AHF index episode) of temperature and AP with the primary and secondary outcomes were investigated. We used restricted cubic splines to model the continuous non-linear association of temperature and AP with each endpoint. Some sensitivity analyses were performed. Patients were discharged after a median LOS of 5days (IQR = 1-10). The highest temperature at discharge ranged from -2 to 41.6°C, and AP was from 892 to 1037hPa. The 7-day post-discharge combined event occurred in 1242 patients (8.4%), with percentages of 7-day ED-revisit, hospitalization and death of 7.8%, 5.1% and 0.9%, respectively. We found no association between the maximal temperature and AP on the day of discharge and the primary or secondary outcomes. Similarly, there were no significant associations when the analyses were restricted to hospitalized patients (median LOS = 7days, IQR = 4-11) during the index event, or when lag-1, lag-2 or the mean of the 3 post-discharge days (instead of point estimation) of ambient temperature and AP were considered. Temperature and AP on the day of patient discharge are not independently associated with the risk of very early adverse events during the vulnerable post-discharge period in patients discharged after an AHF episode.

Factors associated with risk of death by suicide after psychiatric hospitalization by the Unified Health System in Brazil (2002–2015)

ObjectiveTo investigate overall and sex-related characteristics associated with the risk of death by suicide within 365 days of discharge in patients admitted to psychiatric hospitals in the Brazilian Unified Health System (SUS). MethodA non-concurrent prospective cohort of adult patients admitted to psychiatric hospitals in the SUS, from 2002 to 2015. Patients were stratified according to sociodemographic and clinical variables. Adjusted hazard ratios (aHRs) of suicide within 365 days of discharge were estimated using Cox proportional hazard regression models. ResultsThis sample comprised 1,228,784 adult patients admitted to psychiatric hospitals. Of these, 3201 died by suicide within 365 days of discharge. The risk of suicide was positively associated with male sex, age between 18 and 29 years, living in the South region, and living in rural or intermediate municipalities. The highest risk of suicide was among patients with depressive disorders (aHR, 3.87; 95%CI, 3.41–4.38) follow by opioid-related disorders (aHR, 2.71; 95%CI, 2.00–3.67), particularly among female patients. ConclusionPatients with a psychiatric hospital admission should have access to mental health care services immediately after discharge and in the long term. Findings of this study may support suicide prevention policies and have implications for clinical decisions related to patient discharge and follow-up.

Prognosis factors for death within 90 days of discharge in patients with acute kidney injury requiring continuous renal replacement therapy after surgery for Stanford type A acute aortic dissection

Objective: To investigate the prognosis factors for death within 90 days after discharge in patients with acute kidney injury(AKI) treated requiring continuous renal replacement therapy(CRRT) undergoing surgery for acute Standford type A aortic dissection. Methods: The clinic data of 126 patients undergoing CRRT for postoperative AKI after acute type A aortic dissection surgery in the Center for Cardiac Intensive Care, Beijing Anzhen Hospital from July 2016 to February 2019 were analyzed retrospectively. There were 83 males and 43 females, aging (52.9±11.2) years(range: 25 to 70 years). The patients' demographic characteristics, disease-related information, perioperative data, laboratory indexes during CRRT, complications, and survival information within 90 days after discharge were recorded. Independent prognosis factors for death within 90 days of discharge were determined by Kaplan-Meier survival analysis, univariate and multifactorial Cox regression analysis. Results: Totally 57 of 126 patients(45.2%) died over the first 90 days after discharge. Kaplan-Meier survival analysis and univariate Cox regression analysis showed that there were significant differences between the non-survival and survival group including ≥65 years old, high lactate values 12 hours after CRRT, pulmonary infection, liver dysfunction, presence of permanent neurological complications, and postoperative ejection fraction(EF)<45%. Multifactorial Cox regression analysis revealed that ≥65 years old(HR=2.14, 95%CI: 1.09 to 4.21, P=0.03), high lactate values 12 hours after CRRT(HR=1.13, 95%CI: 1.06 to 1.20, P=0.01) and postoperative EF<45%(HR=2.21, 95%CI: 1.09 to 4.51, P=0.03) were independent prognosis factors for patients' death within 90 days after hospital discharge. Conclusions: ≥65 years old, high lactate values 12 hours after CRRT and postoperative EF<45% are independent prognosis factors for death within 90 days after discharge in patients undergoing CRRT for AKI after acute type A aortic dissection surgery. Proper identification and management of prognosis factors could be beneficial to improve patients' outcomes.

Lipid Testing, Lipid-Modifying Therapy, and PCSK9 (Proprotein Convertase Subtilisin-Kexin Type 9) Inhibitor Eligibility in 27 979 Patients With Incident Acute Coronary Syndrome

While registry-based studies have shown that as many as 1 in 2 patients with stable atherosclerotic cardiovascular disease would be eligible for PCSK9i (proprotein convertase subtilisin-kexin type 9 inhibitor) therapy, this has not been studied in a large population-based postacute coronary syndrome (ACS) cohort. We examined lipid testing performed in hospital or within 90 days of discharge and lipid-lowering therapies dispensed within 90 days of discharge in patients surviving for at least 1 year after their first ACS between 2012 and 2018 in the province of Alberta, Canada. We estimated the proportion of patients eligible for PCSK9i and the expected benefits of treatment. Of the 27 979 patients (median age 64.0 years, 29.3% female, 28.0% diabetic), 3750 (13.4%) did not have lipid testing in-hospital or within 90 days postdischarge. Untested patients were more likely to be older, female, from rural areas, to have more comorbidities, to already be on cardioprotective therapies, to present with unstable angina, and were less likely to have invasive interventions (all P<0.0001). Of the 24 229 tested, 18 767 (77.5%) had at least one lipid value above guideline-recommended threshold (LDL [low-density lipoprotein] ≥1.8 mmol/L [70 mg/dL] and non-HDL [high-density lipoprotein] ≥2.6 mmol/L [100 mg/dL]), of which 7284 (38.8%) did not have repeat testing within the year after discharge. Lipid testing in hospital was associated with higher rates of initiation or escalation of statin therapy within 90 days of their ACS (adjusted odds ratio, 2.13 [95% CI, 1.97-2.30). In total, 9592 patients (39.6% of the tested cohort) would be eligible for PCSK9i use, which could result in 184 fewer cardiovascular events over 3.4 years, including cardiovascular death, nonfatal ACS (myocardial infarction or unstable angina requiring hospitalization), and ischemic stroke. Within 90 days of incident ACS, ≈80% of patients did not meet guideline-recommended lipid thresholds and more than one-third would potentially be eligible for PCSK9i.

Complications and Mortality Rates Following Surgical Management of Extradural Spine Tumors in New York State.

Database analysis. To evaluate complications and mortality in patients undergoing surgical management of extradural spinal tumors in New York State. Metastatic spine surgery has a high rate of complications but most studies are limited to single institutions. The Statewide Planning and Research Cooperative System was used to identify patients with extradural spinal tumors undergoing surgery in New York State from 2006 to 2015. Bivariate and multivariate logistic regression analyses were used to estimate outcomes. Four thousand seven hundred sixty-seven patients were identified, the majority of patients were male and white a median age of 61. The complication rate was 17.6% and the mortality rate within 30 days of discharge was 12.2%. Multivariate analysis showed the odds of complications were higher in males compared with females (odds ratio [OR]: 1.27; 95% confidence interval [CI]: 1.05-1.52, P = 0.01), and patients on Medicaid compared with patients on private insurance (OR: 1.42; 95% CI: 1.03-1.96, P = 0.03). Analysis of hospital characteristics showed lower volume hospitals (OR 1.48; 95% CI: 1.03-2.13, P value = 0.03), and teaching hospitals (OR: 1.47; 95% CI: 1.03-2.09, P = 0.04), have higher odds of complications compared with high-volume hospitals and nonteaching hospitals. Multivariate analysis showed higher odds of mortality within 30 days of discharge in patients of older age (OR: 1.02; 95% CI: 1.01-1.03, P value = 0.001), low-volume hospitals compared with high-volume hospitals (OR: 1.36; 95% CI: 1.09-1.79, P value = 0.02), hospitals with low bed size compared with high bed size (OR: 1.43; 95% CI: 1.12-1.83, P value = 0.01), and urban hospitals compared with rural hospitals (OR: 3.04; 95% CI: 2.03-4.56, P value = 0.001). Low-volume hospitals are associated with complications and mortality in patients with metastatic spine disease. 3.

P123 THIRTY DAY READMISSIONS AMONG PATIENTS WITH COMPLICATED INFLAMMATORY BOWEL DISEASE AND EFFECTS ON OUTCOMES: RESULTS OF ANALYSIS OF 2016 NATIONWIDE READMISSION DATABASE

Abstract Objective To determine the rate of hospital readmissions within 30 days of discharge in patients with complicated Inflammatory Bowel Disease (IBD) and its impact on mortality, morbidity, and health care cost in the United States. Methods We performed a retrospective study using the Nationwide Readmission Database(NRD) for the year 2016 (Data on 35.6 million discharges). We collected data on hospital readmissions of 29,356 adults who were hospitalized for complicated Inflammatory Bowel Disease(Crohn’s disease and Ulcerative Colitis) and discharged. Complications were defined using ICD 10 codes. Patients with age less than 18, elective admission and admission during December month were excluded. The primary outcome was rate of all-cause readmission within 30 days of discharge. Secondary outcomes were reasons for readmission, readmission mortality rate, morbidity and resource use. Multivariate regression analysis was used to determine the independent predictors of 30-day readmission. Results Among patients admitted to US hospitals with complicated IBD, the total time at risk was 407,983 days, with the first readmission occurring at day 1 and the last readmission at day 30. The 30-day rate of readmission was 17.6%, with the most common cause of readmission being Crohn’s disease of small intestine with intestinal obstruction (9%). The mortality rate among patients readmitted to the hospital (0.6%), was higher than that for index admissions (0.3%) (P &amp;lt; .01). Mean length of stay was 5.5 days for index admission and 5.9 days for readmission (p=0.01). Mean total charge for index admission was $44,768 compared to $48,766 for readmission (p&amp;lt;0.01). Mean total cost for index admission was $11,491 compared to $12,704 for readmission (p&amp;lt;0.01). A total of 30,943 hospital days were associated with readmission, and the total health care in-hospital economic burden was $65 million (in costs) and $251 million (in charges). Independent predictors of readmission were age, insurance status, higher Charlson comorbidity score, lower income, teaching status of hospital and longer stays in the hospital. Older age, private insurance, median income more than $48,000 were associated with lower odds for readmission, whereas higher comorbidities and admission to teaching hospital were associated with increased odds for readmission. Conclusions In a retrospective study of patients hospitalized for complicated IBD in 2016, 17.6% were readmitted to the hospital within 30 days of discharge. Readmission was associated with higher mortality, morbidity, and resource use. Age, insurance status, higher comorbidity score, lower income and admission to teaching hospital were independent predictors of readmission.

P123 THIRTY DAY READMISSIONS AMONG PATIENTS WITH COMPLICATED INFLAMMATORY BOWEL DISEASE AND EFFECTS ON OUTCOMES: RESULTS OF ANALYSIS OF 2016 NATIONWIDE READMISSION DATABASE

To determine the rate of hospital readmissions within 30 days of discharge in patients with complicated Inflammatory Bowel Disease (IBD) and its impact on mortality, morbidity, and health care cost in the United States.

Influence of Adenosine-5-Triphosphogluconate-Magnesium Trisodium Salt and Levocarnitine on Clinical Course, Structural and Functional Changes and Myocardial Fibrosis in Patients with Myocardial Infarction

Modern strategies of STEMI/NSTEMI management, that include revascularization by coronary stenting, bypass grafting, nowadays are used in 30-40% of urgent patients of such category. The prevalent part of patients is treated by administration of the optimal drug therapy.&#x0D; The objective of the research was to study the influence of adenosine-5-triphosphogluconate-magnesium trisodium salt and levocarnitine on the clinical course of STEMI/NSTEMI.&#x0D; Materials and methods. 100 patients with STEMI/NSTEMI were included into the research. Depending on the therapy scheme, patients were divided into three groups and the control one. Determination of the key parameters was performed initially after hospitalization and at the day of patient discharge.&#x0D; Results. Promising results were shown while slowing the myocardial fibrosing. Limiting of the infarcted and `stunned` myocardium area resulted in ejection fraction increase, increase of the myocardial reserve, measured by echocardiographic indexes.&#x0D; Conclusions. Decreasing of myocardial fibrosing can be potentiated by the pharmacological postconditioning as well as limiting of the necrotic myocardium area and increase of viable myocardium area. Pharmacological postconditioning is effective and save, that can be proved by the absence of any serious complications.

A Medical Resident–Pharmacist Collaboration Improves the Rate of Medication Reconciliation Verification at Discharge

At the Hospital of the University of Pennsylvania (Philadelphia), it is standard practice to perform medication reconciliation at patient discharge. Although pharmacists historically were available to assist resident physicians in the discharge medication reconciliation process, the process was never standardized. An internal review showed a 60%-70% rate of pharmacist review of discharge medication lists, potentially enabling medication errors to go unnoticed during transitions of care. In response, a medical resident- and pharmacist-led collaboration was designed, and a pre-post-intervention study was conducted to assess its effectiveness. A new work flow was established in which house staff notified pharmacists when a preliminary discharge medication list was ready for reconciliation and provided access for pharmacists to correct medication errors in the electronic discharge document with physician approval. Length of stay, average time of day of patient discharge, and readmission data were compared in the pre- and post-intervention periods. There were 981 discharges in the preintervention period and 1,207 in the postintervention period. The rate of pharmacist reconciliation increased from 64.0% to 82.4% after the intervention (p<.0001). The average number of errors identified and corrected by pharmacists decreased from 0.979 to 0.862 per discharge (p<.0001). There was no significant change in readmission rates or time of discharge after the intervention. Redesigning the discharge medication reconciliation process in a teaching hospital to include a review of medical resident discharge medication lists by pharmacists provided more opportunities for discharge medication error identification and correction.

Low serum albumin and total lymphocyte count as predictors of 30 day hospital readmission in patients 65 years of age or older.

Introduction. Hospital readmission within 30 days of discharge is a target for health care cost savings through the medicare Value Based Purchasing initiative. Because of this focus, hospitals and health systems are investing considerable resources into the identification of patients at risk of hospital readmission and designing interventions to reduce the rate of hospital readmission. Malnutrition is a known risk factor for hospital readmission.Materials and Methods. All medical patients 65 years of age or older discharged from Memorial Medical Center from January 1, 2012 to March 31, 2012 who had a determination of serum albumin level and total lymphocyte count on hospital admission were studied retrospectively. Admission serum albumin levels and total lymphocyte counts were used to classify the nutritional status of all patients in the study. Patients with a serum albumin less than 3.5 grams/dL and/or a TLC less than 1,500 cells per mm3 were classified as having protein energy malnutrition. The primary outcome investigated in this study was hospital readmission for any reason within 30 days of discharge.Results. The study population included 1,683 hospital discharges with an average age of 79 years. The majority of the patients were female (55.9%) and had a DRG weight of 1.22 (0.68). 219 patients (13%) were readmitted within 30 days of hospital discharge. Protein energy malnutrition was common in this population. Low albumin was found in 973 (58%) patients and a low TLC was found in 1,152 (68%) patients. Low albumin and low TLC was found in 709 (42%) of patients. Kaplan–Meier analysis shows any laboratory evidence of PEM is a significant (p < 0.001) predictor of hospital readmission. Low serum albumin (p < 0.001) and TLC (p = 0.018) show similar trends. Cox proportional-hazards regression analysis showed low serum albumin (Hazard Ratio 3.27, 95% CI [2.30–4.63]) and higher DRG weight (Hazard Ratio 1.19, 95% CI [1.03–1.38]) to be significant independent predictors of hospital readmission within 30 days.Discussion. This study investigated the relationship of PEM to the rate of hospital readmission within 30 days of discharge in patients 65 years of age or older. These results indicate that laboratory markers of PEM can identify patients at risk of hospital readmission within 30 days of discharge. This risk determination is simple and identifies a potentially modifiable risk factor for readmission: protein energy malnutrition.

Intern Workload and Discontinuity of Care on 30-Day Readmission

Intern Workload and Discontinuity of Care on 30-Day Readmission

Symptoms of anxiety and depression in family members of intensive care unit patients before discharge or death. A prospective multicenter study

Study Objectives More than two thirds of family members visiting intensive care unit (ICU) patients have symptoms of anxiety or depression during the first days of hospitalization. Identifying determinants of these symptoms would help caregivers support families at patient discharge or when death is imminent. Design and Setting Prospective multicenter study including 78 ICUs (1184 beds) in France. Participants Family members completed the Hospital Anxiety and Depression Scale on the day of patient discharge or death to allow evaluation of the prevalence and potential factors associated with symptoms of anxiety and depression. Results Three hundred fifty-seven patients were included in the study, and 544 family members completed the Hospital Anxiety and Depression Scale. Symptoms of anxiety and depression were found in 73.4% and 35.3% of family members, respectively; 75.5% of family members and 82.7% of spouses had symptoms of anxiety or depression ( P = .007). Symptoms of depression were more prevalent in family members of nonsurvivors (48.2%) than of survivors (32.7%) ( P = .008). The multivariate model identified 3 groups of factors associated with symptoms: (1) patient-related: severity as assessed by the Simplified Acute Physiology Score II (odds ratio [OR] 1.017 per point) and patient age (OR 0.984 per year) predicted anxiety, and Simplified Acute Physiology Score II (OR, 1.015 per point), patient death (OR 2.092), and patient age (OR 0.981) predicted depression; (2) family-related: the spouse predicted anxiety (OR 2.085); and (3) ICU-related: a room with more than 1 bed (OR 1.539) predicted depression. Conclusion The prevalence of symptoms of anxiety and depression remains high at the end of the ICU stay, whether the patient is well enough to be discharged or is near death.