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Characteristics and Outcomes of Patients Discharged Directly Home From the Pediatric Intensive Care Unit
Introduction: Patients admitted to the pediatric intensive care unit (PICU) typically transfer to an acute care floor prior to discharge (ACD). Various circumstances, including rapid clinical improvement, technology dependence, or capacity constraints, may lead to discharge directly to home from a P...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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SAGE Publications
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10374988/ https://www.ncbi.nlm.nih.gov/pubmed/36895117 http://dx.doi.org/10.1177/08850666231162530 |
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author | Pizzuto, Matthew F. Sutton, Ashley G. Schroeder, Katherine S. Bravo, Mercedes A. Li, Lang Kihlstrom, Margaret J. |
author_facet | Pizzuto, Matthew F. Sutton, Ashley G. Schroeder, Katherine S. Bravo, Mercedes A. Li, Lang Kihlstrom, Margaret J. |
author_sort | Pizzuto, Matthew F. |
collection | PubMed |
description | Introduction: Patients admitted to the pediatric intensive care unit (PICU) typically transfer to an acute care floor prior to discharge (ACD). Various circumstances, including rapid clinical improvement, technology dependence, or capacity constraints, may lead to discharge directly to home from a PICU (DDH). This practice has been studied in adult intensive care units, but research is lacking for PICU patients. Methods: We aimed to describe characteristics and outcomes of patients requiring PICU admission who experienced DDH versus ACD. We conducted a retrospective cohort study of patients ≤18 years old admitted to our academic, tertiary care PICU between 1/1/15 and 12/31/20. Patients who died or were transferred to another facility were excluded. Baseline characteristics (including home ventilator dependence) and markers of illness severity, specifically the need for vasoactive infusion or new mechanical ventilation, were compared between groups. Admission diagnoses were categorized using the Pediatric Clinical Classification System (PECCS). Our primary outcome was hospital readmission within 30 days. Results: Of 4042 PICU admissions during the study period, 768 (19%) were DDH. Baseline demographic characteristics were similar, although DDH patients were more likely to have a tracheostomy (30% vs 5%, P < .01) and require a home ventilator at discharge (24% vs 1%, P < .01). DDH was associated with being less likely to have required a vasoactive infusion (7% vs 11%, P < .01), shorter median length of stay (LOS) (2.1 days vs 5.9 days, P < .01) and increased rate of readmission within 30 days of discharge (17% vs 14%, P < .05). However, repeat analysis after removing ventilator-dependent patients at discharge (n = 202) showed no difference in rates of readmission (14% vs 14%, P = .88). Conclusions: Direct discharge home from the PICU is a common practice. DDH and ACD groups had similar 30-day readmission rate when patient admissions with home ventilator dependence were excluded. |
format | Online Article Text |
id | pubmed-10374988 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | SAGE Publications |
record_format | MEDLINE/PubMed |
spelling | pubmed-103749882023-07-29 Characteristics and Outcomes of Patients Discharged Directly Home From the Pediatric Intensive Care Unit Pizzuto, Matthew F. Sutton, Ashley G. Schroeder, Katherine S. Bravo, Mercedes A. Li, Lang Kihlstrom, Margaret J. J Intensive Care Med Original Research Introduction: Patients admitted to the pediatric intensive care unit (PICU) typically transfer to an acute care floor prior to discharge (ACD). Various circumstances, including rapid clinical improvement, technology dependence, or capacity constraints, may lead to discharge directly to home from a PICU (DDH). This practice has been studied in adult intensive care units, but research is lacking for PICU patients. Methods: We aimed to describe characteristics and outcomes of patients requiring PICU admission who experienced DDH versus ACD. We conducted a retrospective cohort study of patients ≤18 years old admitted to our academic, tertiary care PICU between 1/1/15 and 12/31/20. Patients who died or were transferred to another facility were excluded. Baseline characteristics (including home ventilator dependence) and markers of illness severity, specifically the need for vasoactive infusion or new mechanical ventilation, were compared between groups. Admission diagnoses were categorized using the Pediatric Clinical Classification System (PECCS). Our primary outcome was hospital readmission within 30 days. Results: Of 4042 PICU admissions during the study period, 768 (19%) were DDH. Baseline demographic characteristics were similar, although DDH patients were more likely to have a tracheostomy (30% vs 5%, P < .01) and require a home ventilator at discharge (24% vs 1%, P < .01). DDH was associated with being less likely to have required a vasoactive infusion (7% vs 11%, P < .01), shorter median length of stay (LOS) (2.1 days vs 5.9 days, P < .01) and increased rate of readmission within 30 days of discharge (17% vs 14%, P < .05). However, repeat analysis after removing ventilator-dependent patients at discharge (n = 202) showed no difference in rates of readmission (14% vs 14%, P = .88). Conclusions: Direct discharge home from the PICU is a common practice. DDH and ACD groups had similar 30-day readmission rate when patient admissions with home ventilator dependence were excluded. SAGE Publications 2023-03-09 2023-08 /pmc/articles/PMC10374988/ /pubmed/36895117 http://dx.doi.org/10.1177/08850666231162530 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by-nc/4.0/This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (https://us.sagepub.com/en-us/nam/open-access-at-sage). |
spellingShingle | Original Research Pizzuto, Matthew F. Sutton, Ashley G. Schroeder, Katherine S. Bravo, Mercedes A. Li, Lang Kihlstrom, Margaret J. Characteristics and Outcomes of Patients Discharged Directly Home From the Pediatric Intensive Care Unit |
title | Characteristics and Outcomes of Patients Discharged Directly Home From the Pediatric Intensive Care Unit |
title_full | Characteristics and Outcomes of Patients Discharged Directly Home From the Pediatric Intensive Care Unit |
title_fullStr | Characteristics and Outcomes of Patients Discharged Directly Home From the Pediatric Intensive Care Unit |
title_full_unstemmed | Characteristics and Outcomes of Patients Discharged Directly Home From the Pediatric Intensive Care Unit |
title_short | Characteristics and Outcomes of Patients Discharged Directly Home From the Pediatric Intensive Care Unit |
title_sort | characteristics and outcomes of patients discharged directly home from the pediatric intensive care unit |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10374988/ https://www.ncbi.nlm.nih.gov/pubmed/36895117 http://dx.doi.org/10.1177/08850666231162530 |
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