Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2017 Jul 27;12(7):e0181827.
doi: 10.1371/journal.pone.0181827. eCollection 2017.

Intensive care discharge delay is associated with increased hospital length of stay: A multicentre prospective observational study

Ravindranath Tiruvoipati  1   2 , John Botha  1   2 , Jason Fletcher  3 , Himangsu Gangopadhyay  4 , Mainak Majumdar  5 , Sanjiv Vij  6 , Eldho Paul  7   8 , David Pilcher  7   9 ; Australia and New Zealand Intensive Care Society (ANZICS) Clinical Trials Group
Affiliations
Observational Study

Intensive care discharge delay is associated with increased hospital length of stay: A multicentre prospective observational study

Ravindranath Tiruvoipati et al. PLoS One. .

Abstract

Background: Some patients experience a delayed discharge from the intensive care unit (ICU) where the intended and actual discharge times do not coincide. The clinical implications of this remain unclear.

Objective: To determine the incidence and duration of delayed ICU discharge, identify the reasons for delay and evaluate the clinical consequences.

Methods: Prospective multi-centre observational study involving five ICUs over a 3-month period. Delay in discharge was defined as >6 hours from the planned discharge time. The primary outcome measure was hospital length stay after ICU discharge decision. Secondary outcome measures included ICU discharge after-hours, incidence of delirium, survival to hospital discharge, discharge destination, the incidence of ICU acquired infections, revocation of ICU discharge decision, unplanned readmissions to ICU within 72 hours, review of patients admitting team after ICU discharge decision.

Results: A total of 955 out of 1118 patients discharged were included in analysis. 49.9% of the patients discharge was delayed. The most common reason (74%) for delay in discharge was non-availability of ward bed. The median duration of the delay was 24 hours. On univariable analysis, the duration of hospital stay from the time of ICU discharge decision was significantly higher in patients who had ICU discharge delay (Median days-5 vs 6; p = 0.003). After-hours discharge was higher in patients whose discharge was delayed (34% Vs 10%; p<0.001). There was no statistically significant difference in the other secondary outcomes analysed. Multivariable analysis adjusting for known confounders revealed delayed ICU discharge was independently associated with increased hospital length of stay.

Conclusion: Half of all ICU patients experienced a delay in ICU discharge. Delayed discharge was associated with increased hospital length of stay.

PubMed Disclaimer

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Description of patient recruitment.
Fig 2
Fig 2. Comparison of ICU, ward and total hospital length of stay between patients with and without a delay in ICU discharge.
Fig 3
Fig 3. Incidence of delirium after ICU discharge decision to 48 hours in ward.
See this image and copyright information in PMC

References

    1. Bhonagiri D, Pilcher DV, Bailey MJ. Increased mortality associated with after-hours and weekend admission to the intensive care unit: a retrospective analysis. Med J Aust. 2011;194(6):287–92. - PubMed
    1. Goldfrad C, Rowan K. Consequences of discharges from intensive care at night. Lancet. 2000;355(9210):1138–42. doi: 10.1016/S0140-6736(00)02062-6 - DOI - PubMed
    1. Pilcher DV, Duke GJ, George C, Bailey MJ, Hart G. After-hours discharge from intensive care increases the risk of readmission and death. Anaesth Intensive Care. 2007;35(4):477–85. - PubMed
    1. Intensive care Clinical Indicator User Manual v. http://www.achs.org.au. 2016.
    1. Drouot X, Cabello B, d'Ortho MP, Brochard L. Sleep in the intensive care unit. Sleep Med Rev. 2008;12(5):391–403. doi: 10.1016/j.smrv.2007.11.004 - DOI - PubMed

Publication types

LinkOut - more resources