Objective
The study authors sought to determine if delayed discharge from the intensive care
unit (ICU) secondary to a lack of floor beds led to longer postoperative hospital
length of stay (LOS) or more hospital readmissions.
Design
A retrospective study comparing patients with delayed discharge from the ICU to patients
without delayed discharge.
Setting
At a cardiovascular ICU in a tertiary care university hospital.
Participants
A total of 5,777 patients that were ready for discharge from the ICU after recovering
from cardiac surgery.
Interventions
None.
Measurements and Main Results
The authors used linear regression to measure postoperative hospital LOS and logistic
regression to measure hospital readmission in patients whose transfer out of the ICU
was delayed at least overnight to patients who were transferred out the same day.
There were 3,903 patients transferred to the stepdown unit on the same day as the
transfer order and 1,874 patients were transferred on a subsequent day. The postoperative
LOS was shorter in the no delay group (9 ± 9 v 11 ± 10 days, standardized difference = 0.162), whereas the stepdown unit stay was
similar (6 ± 6 v 5 ± 6 days, standardized difference = 0.076). The readmission rates were 15% in the
no delay group versus 14% in the delayed discharge group (standardized difference = 0.032).
After adjustment, the authors found by linear regression that delayed discharge was
associated with an increase (0.72 [95% CI 0.43-1.01] days, p < 0.001) in postoperative
LOS but was not associated with readmission.
Conclusions
The study authors found that patients who had their discharge from the ICU delayed
had an increased hospital LOS but a similar rate of hospital readmission.
Key Words
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References
- Feasibility of discharge planning in intensive care units: A pilot study.Am J Crit Care. 2012; 21: e94-e101
- Applying STAAR interventions in incremental bundles: Improving post-CABG surgical patient care.Worldviews Evid Based Nurs. 2014; 11: 89-97
- Educational intervention reduces complications and rehospitalization after heart surgery.West J Nurs Res. 2013; 35: 1251-1265
- Prevention of 30-day readmission after coronary artery bypass surgery.Home Healthc Now. 2017; 35: 326-334
- Impact of warfarin discharge education program on hospital readmission and treatment costs.Int J Clin Pharm. 2018; 40: 721-729
- Impact of intensive care unit discharge delays on patient outcomes: A retrospective cohort study.J Intensive Care Med. 2019; 34: 924-929
- Intensive care discharge delay is associated with increased hospital length of stay: A multicentre prospective observational study.PLoS One. 2017; 12e0181827
- Delay of transfer from the intensive care unit: A prospective observational analysis on economic effects of delayed in-house transfer.Eur J Med Res. 2019; 24: 30
- Optimal timing of transfer out of the intensive care unit.Am J Crit Care. 2013; 22: 390-397
- Delay of transfer from the intensive care unit: A prospective observational study of incidence, causes, and financial impact.Crit Care. 2013; 17: R128
- Reducing hospital readmission rates: Current strategies and future directions.Annu Rev Med. 2014; 65: 471-485
- Association between hospital penalty status under the hospital readmission reduction program and readmission rates for target and nontarget conditions.JAMA. 2016; 316: 2647-2656
- Readmissions after cardiac surgery: Experience of the National Institutes of Health/Canadian Institutes of Health research cardiothoracic surgical trials network.Ann Thorac Surg. 2014; 98: 1274-1280
- Uniform standards do not apply to readmission following coronary artery bypass surgery: A multi-institutional study.J Thorac Cardiovasc Surg. 2015; 149 (850-7.e1)
- Rehospitalizations among patients in the Medicare fee-for-service program.N Engl J Med. 2009; 360: 1418-1428
- Using effect size-or why the P value is not enough.J Grad Med Educ. 2012; 4: 279-282
U.S. Centers for Medicare and Medicaid Services. National health expenditure data. Available at: https://www.cms.gov/research-statistics-data-and-systems/statistics-trends-and-reports/nationalhealthexpenddata/. Accessed June 15, 2022.
- ICU occupancy and mechanical ventilator use in the United States.Crit Care Med. 2013; 41: 2712-2719
Article info
Publication history
Published online: September 30, 2022
Footnotes
This research was supported solely by institutional funds.
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
