Hi it’s Patrik Hutzel from INTENSIVE CARE AT HOME where we provide tailor made solutions for long-term ventilated Adults& Children with Tracheostomies and otherwise medically complex Patients by improving their Quality of life and where we also provide tailor made solutions to hospitals and Intensive Care Units to save money and resources, whilst providing Quality Care!
In the last blog I shared
You can check out last week’s episode by clicking on the link here.
Today’s blog ties right in with the last blog where we compared INTENSIVE CARE AT HOME and long-term Intensive Care stay!
In today’s blog I want to share a recent Canadian study by Henry T. Stelfox, MD, PhD, from University of Calgary, Alberta, and colleagues, that confirms that discharging Patients from ICU to home is becoming more and more mainstream!
Discharging patients home from ICU poses no added risk!
I let the study speak for itself, it just confirms that ICU long-term stays are not sustainable from a financial, bed block and quality of life point of view.
People can go home with the right discharge planning and with the right support structure like having ICU nurses come to their home some in the short term and some long-term!
The study recommends what we have been saying since the beginning of starting our journey that ICUs need to develop discharge procedures that include identification of candidate patients for discharge directly home, develop protocols to facilitate the process, train ICU clinicians in these procedures, send patients home with appropriate support and measure outcomes.
We certainly measure outcomes and our clients have very low readmission rates to hospital or ICU in spite of mechanical ventilation, tracheostomy and/or other medical complexities. ICU nursing skills in the home make this possible.
Here is a link to the published study or you can read it below
Direct discharge home from the ICU does not increase health care utilization or mortality, according to research published in JAMA Internal Medicine.
“The safety of discharging adult patients recovering from critical illness directly home from the intensive care unit (ICU) is unknown,” Henry T. Stelfox, MD, PhD, from University of Calgary, Alberta, and colleagues wrote.
Stelfox and colleagues performed a retrospective population-based cohort study to determine the health care utilization and clinical outcomes for patients discharged directly home from the ICU compared with those discharged home via the hospital ward.
The researchers enrolled 6,732 adult patients (median age, 56 years; 42% women) admitted to one of nine medical-surgical hospitals. Participants were followed for 1 year after hospital discharge.
Overall, 14% of participants were discharged directly home, while the rest went to the hospital ward, from which they were ultimately discharged. Direct discharges home from the ICU ranged significantly across hospitals from 4.4% to 44%.
Patients discharged directly home were more likely to be younger (median age, 47 vs. 57 years); to have been admitted to the hospital due to overdose, substance withdrawal, seizures or metabolic coma (32% vs. 10%); to have less severe acute illness on ICU admission (median APACHE II score, 15 vs. 18) and to have received less than 48 hours of invasive mechanical ventilation (42% vs. 34%) than those discharged home via hospital ward.
In the propensity score matched cohort (n = 1632), there were similar lengths of ICU stays among patients discharged directly home and those discharged home via the hospital ward (median, 3.1 days vs. 3 days); however, length of hospital stay was significantly shorter among those discharged directly home (median, 3.3 days vs. 9.2 days).
Readmission to the hospital (10% vs. 11%; HR = 0.88; 95% CI, 0.64-1.2) or ED visit (25% vs. 26%; HR = 0.94; 95% CI, 0.81-1.09) within 30 days of hospital discharge did not significantly differ between the two groups. Risk factors for readmission to the hospital or ED visits included leaving against medical advice, lack of community supports and discharge from an ICU with high volumes of patients, according to the researchers.
The percentage of patients who died within 1 year of hospital discharge was the same in both groups (4%; HR = 0.9; 95% CI, 0.6-1.35).
“We recommend that ICUs develop discharge procedures that include identification of candidate patients for discharge directly home, develop protocols to facilitate the process, train ICU clinicians in these procedures, and measure outcomes,” Stelfox and colleagues concluded.
In an accompanying editorial, Kyan Safavi, MD, MBA, from Massachusetts General Hospital, and colleagues suggest that direct discharge from the ICU may help to reduce congestion both in the ICU and on the floors.
“It is important, however, that strategies are also pursued to ensure safe and timely discharge from the general care unit, and studies are needed to investigate the factors that are keeping patients on the wards beyond the time needed,” they wrote. – by Alaina Tedesco
If you want to find out how we can help you to get your loved one out of Intensive Care including palliative care or Long-term acute care(also nursing home) or if you find that you have insufficient support for your loved one at home on a ventilator, if you want to know how to get funding for our service or if you have any questions please send me an email to [email protected] or call on one of the numbers below.
Australia/New Zealand +61 41 094 2230
USA/Canada +1 415-915-0090
UK/Ireland +44 118 324 3018
Also, check out our careers section here
We are currently hiring ICU/PICU nurses for clients in Melbourne, Sunbury and in South Gippsland/Victoria.
We are an NDIS, TAC (Victoria) and DVA (Department of Veteran affairs) approved community service provider in Australia.
We have also been part of the Royal Melbourne health accelerator program for innovative health care companies last year!
Thank you for tuning into this week’s blog.
This is Patrik Hutzel from INTENSIVE CARE AT HOME and I see you again next week in another update!