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Factors associated with discharge delay and direct discharge home from paediatric intensive care
Tessa K Kennedy1,2, Andrew Numa1,2
1Children's Intensive Care Unit, Sydney Children's Hospital, Sydney, New South Wales, Australia.
Insights
Direct discharge home from paediatric intensive care increased significantly, linked to longer delays and changing patient profiles, particularly for bronchiolitis cases. This highlights a need to optimize intensive care unit resource utilization.
Area of Science:
- Pediatric Critical Care Medicine
- Health Services Research
- Hospital Administration
Background:
- Direct discharge home from pediatric intensive care units (PICU) is a critical pathway for patient flow.
- Understanding factors influencing this discharge route is essential for efficient resource allocation.
- Organizational changes and evolving clinical practices may impact discharge patterns.
Purpose of the Study:
- To investigate patient and hospital admission characteristics associated with direct home discharge from PICU.
- To analyze trends in direct home discharge rates over a decade.
- To identify factors contributing to delays in discharge for patients going home directly.
Main Methods:
- Retrospective analysis of PICU admissions over a 10-year period (2007-2016) at a single tertiary center.
- Comparison of patient and admission characteristics between direct-to-home and ward-discharged groups.
- Division of data into two epochs based on health service structure changes.
Main Results:
- Annual direct home discharge rate from PICU significantly increased from 3.7% to 9.5% (P < 0.0001).
- Patients discharged home experienced significantly more discharge delays (46.4% vs. 30.7%, P < 0.0001), often exceeding 24 hours.
- Bronchiolitis admissions increased and were over-represented among direct home discharges.
Conclusions:
- Increased direct home discharge rates are linked to discharge delays and shifts in patient demographics, possibly due to organizational restructuring.
- The rise in bronchiolitis cases influences direct discharge patterns.
- There is a need to ensure healthcare systems effectively support appropriate utilization of intensive care resources.
Aim:
To examine the patient and hospital admission characteristics associated with direct discharge home from paediatric intensive care.
Methods:
This was a single-centre retrospective analysis of all admissions to a tertiary metropolitan general paediatric intensive care unit (ICU) surviving to discharge over a 10-year period between 1 January 2007 and 31 December 2016, divided into two epochs defined by changes in health service structure. Patient and admission characteristics were compared between groups discharged direct to home and discharged to ward across these two epochs.
Results:
There was a marked increase in the annual rate of direct discharge to home from ICU between the two epochs (3.7-9.5%, P < 0.0001). There was an inverse relationship between monthly ICU activity and rates of direct discharge to home. Patients discharged directly home were significantly more likely to experience delay to discharge (46.4 vs. 30.7%, P < 0.0001), for that delay to exceed 24 h and comprise a greater proportion of total ICU length of stay. Bronchiolitis accounted for an increasing proportion of admissions between epochs (7.0-15.1%) and was over-represented among patients discharged direct to home (up to 18.2%).
Conclusions:
The high observed rate of direct discharge home is likely to have resulted from increased delays to discharge and changes to patient admission characteristics, attributable to organisational restructuring and possibly changing approaches to clinical management of bronchiolitis. It is imperative to now consider how we ensure that our systems support the proper use of intensive care resources.
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