Impact of the premature discharge on hospital mortality after a stay in an intensive care unit

Rodríguez-Carvajal, M.; Mora, D.; Doblas, A.; García, M.; Domínguez, P.; Tristancho, A.; Herrera, M.

doi:10.1016/S2173-5727(11)70018-2

Article information

Abstract

Objective

To determine the frequency and to evaluate the relationship between premature discharge and post-ICU hospital mortality.

Design

A prospective registry was made for patients admitted during six consecutive years, performing a retrospective analysis of the data on the first admission of ICU survivors.

Setting

A 10-bed general ICU in a 540-bed tertiary-care community hospital.

Patients

1,521 patients with an ICU stay longer than 12 hours, discharged alive to wards with known hospital outcome.

Interventions

None.

Main variables

We recorded the patient data, including types of ICU discharge, normal or premature, and studying their relationship with post-ICU hospital mortality. The types of ICU discharge were also evaluated versus ICU readmission rate and post-ICU length of stay.

Results

There were 165 patients (10.8%) with premature discharge. Mortality rate was 11.6% (176 patients). The factors related with mortality were withdrawal and limitation of lifesustaining treatments (OR=14.02 4.6–42.6), readmissions to ICU (OR=3.46 1.76–6.78), premature discharge (OR=2.6 1.06–4.41), higher organ failure score on discharge from the ICU (OR=1.16 1.01–1.32) and age (OR=1.03 1.01–1.05). Readmission rates and post-ICU length of stay were similar among patients with premature and normal discharge (7.3% vs. 8.2%, P=.68 and 16.7±16.7 days vs. 18.7±21.3 days, respectively, P=162).

Conclusions

Premature discharges appear to be common in our setting and have a significant impact on mortality. Types of ICU discharge do not seem to be related with other outcome variables in the hospital care of critically ill patients.

Keywords:

Intensive care unit

Patient discharge

Withdrawing treatment

In-hospital mortality

Patient readmission

Outcome

Resumen

Objetivos

Comprobar la frecuencia de altas no programadas y su relación con la mortalidad hospitalaria tras la estancia en UCI.

Diseño

Registro prospectivo de los ingresos de 6 años consecutivos. Análisis retrospectivo de la primera admisión de la cohorte de los supervivientes a UCI.

Ámbito

UCI polivalente de 10 camas en hospital general de segundo nivel con 540 camas.

Pacientes

1.521 pacientes con más de 12 horas de estancia, dados de alta vivos y con desenlace hospitalario conocido.

Intervenciones

Ninguna.

Principales variables de interés

Se registró el tipo de alta de la unidad, normal o no programada, y se exploró su relación con la mortalidad hospitalaria post-UCI, las tasas de readmisión y la estancia hospitalaria post-UCI.

Resultados

Hubo 165 altas no programadas (10,8%). La tasa de mortalidad fue del 11,6% (176 pacientes). Los factores relacionados con la mortalidad fueron la limitación del esfuerzo terapéutico (OR=14,02 4,6–42,6), las readmisiones (OR=3,46 1,76–6,78), las altas no programadas (OR=2,16 1,06–4,41), la puntuación de fallos orgánicos al alta de UCI (OR=1,16 1,01–1,32) y la edad (OR=1,03 1,01–1,05). Las readmisiones y las estancias post-UCI no diferían significativamente entre las altas no programadas y las normales (el 7,3 frente al 8,2%; p=0,68 y 16, 7±16,7 frente a 18,7±21,3 días, respectivamente; p=0,162).

Conclusiones

Las altas no programadas son frecuentes en nuestro medio y contribuyen significativamente a la mortalidad post-UCI, sin que parezcan afectar a otros resultados de la asistencia a pacientes críticos.

Palabras clave:

UCI

Altas no programadas

LET

Mortalidad hospitalaria post-UCI

Readmisión

SOFA

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References

[1.]

M.A. Metcalfe, A. Slogget, K. McPherson.

Mortality among appropriately referred patients refused admission to intensivecare units.

Lancet, 350 (1997), pp. 7-12

http://dx.doi.org/10.1016/S0140-6736(96)10018-0 | Medline

[2.]

G.M. Joynt, C.D. Gomersall, P. Tan, A. Lee, C. Ai Yu Cheng, E.L. Lai Yi Wong.

Prospective evaluation of patients refused admission to an intensive care unit: Triage, futility and outcome.

Intensive Care Med, 27 (2001), pp. 1459-1465

http://dx.doi.org/10.1007/s001340101041 | Medline

[3.]

Task Force of the American College of Critical Care Medicine.

Society of Critical Care Medicine: Guidelines for intensive care unit admission, discharge, and triage.

Crit Care Med, 27 (1999), pp. 633-638

Medline

[4.]

C.P. Heidegger, M. Treggiari, J.A. Romand.

and Swiss ICU Network. A nationwide survey of intensive care unit discharge practices.

Intensive Care Med, 31 (2005), pp. 1676-1682

http://dx.doi.org/10.1007/s00134-005-2831-x | Medline

[5.]

R. Moreno, D. Reis Miranda, R. Matos, T. Fevereiro.

Mortality after discharge from intensive care: the impact of organ system failure and nursing workload use at discharge.

Intensive Care Med, 27 (2001), pp. 999-1004

Medline

[6.]

K. Daly, R. Beale, R.W. Chang.

Reduction in mortality after inappropriate early discharge from intensive care unit: logistic regression triage model.

BMJ, 322 (2001), pp. 1274-1276

Medline

[7.]

R. Fernández, J.M. Serrano, I. Umarán, R. Abizanda, A. Carrillo, M.J. López-Pueyo, et al.

Ward mortality after ICU discharge: a multicenter validation of the Sabadell score.

Intensive Care Med, 36 (2010), pp. 1196-1201

http://dx.doi.org/10.1007/s00134-010-1825-5 | Medline

[8.]

C. Goldfrad, K. Rowan.

Consequences of discharges from intensive care at night.

Lancet, 355 (2000), pp. 1138-1142

http://dx.doi.org/10.1016/S0140-6736(00)02062-6 | Medline

[9.]

F.A. Priestap, C.M. Martin.

Impact of intensive care unit discharge time on patient outcome.

Crit Care Med, 34 (2006), pp. 2946-2951

http://dx.doi.org/10.1097/01.CCM.0000247721.97008.6F | Medline

[10.]

A. Usaro, A. Kari, E. Ruokonen.

The effects of ICU admission and discharge time on mortality in Finland.

Intensive Care Med, 29 (2003), pp. 2144-2148

http://dx.doi.org/10.1007/s00134-003-2035-1 | Medline

[11.]

G.J. Duke, J.V. Green, J.H. Briedis.

Night-shift discharge from intensive care unit increases the mortality-risk of ICU survivors.

Anaesth Intensive Care, 32 (2004), pp. 697-701

Medline

[12.]

G. Iapichino, A. Morabito, G. Mistraletti, L. Feria, D. Radrizzani, D. Reis Miranda.

Determinants of post-intensive care mortality in high-level treated critically ill patients.

Intensive Care Med, 29 (2003), pp. 1751-1756

http://dx.doi.org/10.1007/s00134-003-1915-8 | Medline

[13.]

W.A. Knaus, E.A. Draper, D.P. Wagner, J.M. Zimmerman.

APACHE II—a severity of disease classification system.

Crit Care Med, 13 (1985), pp. 818-829

Medline

[14.]

J.L. Vincent, R. Moreno, J. Takala, S. Willatts, A. De Mendonça, H. Bruining, et al.

The SOFA (Sepsis-related organ failure assessment) score to describe organ dysfunction/failure.

Intensive Care Med, 22 (1996), pp. 707-710

Medline

[15.]

R. Moreno, J.L. Vincent, R. Matos, A. Mendonça, F. Cantraine, L. Thijs, et al.

The use of maximum SOFA score to quantify organ dysfunction/failure.

Intensive Care Med, 25 (1999), pp. 686-696

Medline

[16.]

D. Reis-Miranda, R. Moreno, G. Iapichino.

Nine equivalents of nursing manpower use score (NEMS).

Intensive Care Med, 23 (1997), pp. 760-765

Medline

[17.]

A. Tobin, J. Santamaría.

After-hours discharges from intensive care are associated with increased mortality.

MJA, 184 (2006), pp. 334-337

Medline

[18.]

D.R. Goldhill, A. Summer.

Outcome of intensive care patients in a group of British intensive care units.

Crit Care Med, 26 (1998), pp. 1337-1345

Medline

[19.]

C. Wallis, H. Davies, A. Shearer.

Why do patients die on general wards after discharge from intensive care units?.

Anaesthesia, 52 (1997), pp. 9-14

Medline

[20.]

E. Azoulay, C. Adrie, A. De Lassence, F. Pochard, D. Moreau, G. Thiery, et al.

Determinants of postintensive care unit mortality: A prospective multicenter study.

Crit Care Med, 31 (2003), pp. 428-432

http://dx.doi.org/10.1097/01.CCM.0000048622.01013.88 | Medline

[21.]

A. Esteban, F. Gordo, J.F. Solsona, I. Alía, J. Caballero, C. Bouza, et al.

Withdrawing and withholding life support in the intensive care unit: a Spanish prospective multi-centre observational study.

Intensive Care Med, 27 (2001), pp. 1744-1749

http://dx.doi.org/10.1007/s00134-001-1111-7 | Medline

[22.]

H. Wunsch, D.A. Harrison, S. Harvey, K. Rowan.

End-of-life decisions: a cohort study of the withdrawal of all active treatment in intensive care units in the United Kingdom.

Intensive Care Med, 31 (2005), pp. 823-831

http://dx.doi.org/10.1007/s00134-005-2644-y | Medline

[23.]

C.A. Chrusch, K.P. Olafson, P.M. McMillan, D.E. Roberts, P.R. Gray.

High occupancy increases the risk of early death or readmission after transfer from intensive care.

Crit Care Med, 37 (2009), pp. 2753-2758

http://dx.doi.org/10.1097/CCM.0b013e3181a57b0c | Medline

[24.]

T. Hanane, M.T. Keegan, E. Seferian, O. Gajic, B. Afeas.

The association between nighttime transfer from the intensive care unit and patient outcome.

Crit Care Med, 36 (2008), pp. 2232-2237

http://dx.doi.org/10.1097/CCM.0b013e3181809ca9 | Medline

[25.]

Y. Sakr, J.L. Vincent, E. Ruokonen, M. Pizzamiglio, E. Installe, K. Reinhart, et al.

Sepsis and organ system failure are major determinants of post–intensive care unit mortality.

Journal of Critical Care, 23 (2008), pp. 475-483

http://dx.doi.org/10.1016/j.jcrc.2007.09.006 | Medline

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