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Return-to-Care After Discharge Directly Home From the PICU: A Propensity-Matched Cohort Study
Leslie A Dervan1,2, Julia A Heneghan3, Matt Hall4
1Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington, Seattle, WA.
Summary
Children discharged directly home from the pediatric intensive care unit (PICU) have similar return-to-emergency department (ED) and readmission rates as those transferred to acute care. This approach offers potential healthcare system efficiencies.
Area of Science:
- Pediatric critical care medicine
- Health services research
- Hospital discharge outcomes
Background:
- Discharge pathways for pediatric intensive care unit (PICU) patients vary, with some going directly home and others transferring to acute care wards before discharge.
- Understanding the comparative outcomes of these different discharge strategies is crucial for optimizing patient care and healthcare resource utilization.
Purpose of the Study:
- To compare the rates of return to the emergency department (ED) or hospital readmission within 14 days for pediatric patients discharged directly home from the PICU versus those transferred to an acute care ward prior to discharge.
- To evaluate the associated healthcare costs for these two discharge pathways.
Main Methods:
- A propensity-matched, multicenter cohort study was conducted using data from 45 U.S. hospitals participating in the Pediatric Health Information Systems database.
- The study included children admitted to a non-neonatal cardiac or general PICU between 2016 and 2023.
- Propensity score matching was used to compare children discharged directly home with those transferred to a ward, controlling for factors like admission year, type, and principal diagnosis.
Main Results:
- Out of 560,815 PICU discharges, 26.8% were discharged directly home.
- Children discharged directly home had similar rates of return-to-ED care (2.9% vs. 3.0%) and 14-day hospital readmission (4.8% vs. 4.9%) compared to ward-transferred peers.
- However, children discharged directly home were more likely to be readmitted to a PICU (2.4% vs. 1.6%), and their index hospitalization costs were lower, resulting in reduced overall inpatient healthcare costs over 14 days.
Conclusions:
- Direct discharge home from the PICU is a common practice and is associated with comparable rates of return-to-care as discharge via an acute care ward.
- While readmission to the PICU is more frequent for directly discharged patients, the overall healthcare costs are lower.
- Direct discharge home from the PICU may represent an efficient strategy for appropriate pediatric patients, warranting consideration for healthcare system optimization.
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