Outcomes/Effectiveness Research

Certain factors linked to risk of early death of intensive care patients after discharge

Early death after hospital discharge for patients treated in a hospital intensive care unit (ICU) is associated with patient treatment preferences and decisions about the timing and location of discharge, according to a new study. The risk of dying after hospital discharge, but within 30 days of ICU admission, rose with greater severity of illness. The risk of early postdischarge mortality declined by 67 percent for patients with no limitations on care ("full-code status") at ICU admission. Compared with discharge to home, discharge to an outside acute care hospital increased this risk more than threefold (hazard ratio [HR] of 3.18) or nearly threefold (HR of 2.71) for discharge to a skilled nursing or rehabilitation facility. Patients with short ICU stays (less than 1 day) ran nearly twice the risk of early postdischarge death (HR of 1.86) as those treated in the ICU for between 1 and 7 days.

The researchers solicited participation from among the 308 California hospitals with at least 50 hospital beds. Patient chart data was collected between 2001 and 2004 on 8,484 adult patients who had ICU stays of 4 hours or longer. Based on their findings, the researchers suggest that paying attention to factors influencing early postdischarge mortality can be important in attempts to measure or improve ICU performance. The study was funded in part by the Agency for Healthcare Research and Quality (HS13919).

More details are in "Predictors of early postdischarge mortality in critically ill patients: A retrospective cohort study from the California Intensive Care Outcomes Project," by Eduard E. Vasilevskis, M.D., Michael W. Kuzniewicz, M.D., M.P.H., Brian A. Cason, M.D., R. Adams Dudley, M.D., M.B.A., and others in the February 2011 Journal of Critical Care 26(1), pp. 65-75.

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