Discharge home from critical care: safety assessment in a resource constrained system

Background High bed occupancy rates have delayed patient discharges from UK critical care units, especially in acute medical hospitals. As a result, more patients are discharged home directly from critical care (DH). 

Methods In this observational, retrospective study, we quantify the trends in DH from 2013 to 2018, and assess readmission rates and outcome in this group when compared to patients discharged from a ward, from 2014 to 2016. 

Results DH rates, as a proportion of critical care admissions, increased every year (2.47% in 2013 to 19.36% in 2018). In 2014–16, the most common admission diagnoses in DH patients were diabetic ketoacidosis (DKA; 35%), drug overdose (12%), seizures (8%) and respiratory failure (8%). DH patients were younger and had shorter critical care stay. Readmission rates in DH patients were comparable to the rest of the hospital. Patients with DKA and seizures were more likely to be readmitted. 

Conclusions Our data suggest that direct home discharge from critical care is increasingly common but safe in selected patient groups.