@article{14195,
  author = {Vincent Issac Lau and Fran A. Priestap and Joyce N. H Lam and John Basmaji and Ian M Ball},
  title = {Clinical predictors for unsafe direct discharge home patients from intensive care units},
  abstract = {<jats:sec><jats:title>Purpose:</jats:title><jats:p> To describe factors (demographics and clinical characteristics) that predict patients who are at an increased risk of adverse events or unplanned return visits to a health-care facility following discharge direct to home (DDH) from intensive care units (ICUs). </jats:p></jats:sec><jats:sec><jats:title>Methods:</jats:title><jats:p> Prospective cohort study of all adult patients who survived their stay in our medical–surgical–trauma ICU between February 2016 and 2017 and were discharged directly home. Patients were followed for 8 weeks postdischarge. Univariable and multivariable logistic regression analyses were performed to identify factors associated with adverse events or unplanned return visits to a health-care facility following DDH from ICU. </jats:p></jats:sec><jats:sec><jats:title>Results:</jats:title><jats:p> A total of 129 DDH patients were enrolled and completed the 8-week follow-up. We identified 39 unplanned return visits (URVs). There was 0% mortality at 8 weeks postdischarge. Eight potential predictors of hospital URVs ( P &lt; .2) were identified in the univariable analysis: prior substance abuse (odds ratio [OR] of URV of 2.50 [95% confidence interval: 1.08-5.80], hepatitis (OR: 6.92 [1.68-28.48]), sepsis (OR: 11.03 [1.19-102.29]), admission nine equivalents of nursing manpower score (NEMS) &lt;24 (OR: 2.28 [1.03-5.04], no fixed address (OR: 22.9 [1.2-437.3]), ICU length of stay (LOS) &lt;2 days (OR: 2.95 [1.28-6.78]), home discharge within London, Ontario (OR: 2.44 [1.00-5.92]), and left against medical advice (AMA; OR: 6.06 [2.04-17.98]). </jats:p></jats:sec><jats:sec><jats:title>Conclusions:</jats:title><jats:p> Our study identified 8 covariates that were potential predictors of URV: prior substance abuse, hepatitis, sepsis, admission NEMS &lt;24, no fixed address, ICU LOS &lt;2 days, home discharge within London, Ontario, and left AMA. The practice of direct discharges home from the ICU would benefit from adequately powered multicenter study in order to construct a clinical prediction model (that would require further testing and validation). </jats:p></jats:sec>},
  year = {2020},
  journal = {J Intensive Care Med},
  volume = {35},
  chapter = {1067-1073},
  pages = {1067-1073},
  month = {11/2018},
  issn = {0885-0666},
  doi = {10.1177/0885066618811810},
}