Patient factors associated with hospital discharge to care facility following critical illness

Background— Many critically ill (CI) patients are transferred to other care facilities instead of to home at hospital discharge. Objective— To identify patient factors associated with hospital discharge to care facility following CI, and to estimate the magnitude of risk associated with each factor. Methods— Retrospective cohort study conducted in a medical intensive care unit. We studied 548 survivors of CI. Multivariable logistic regression was employed to identify independent risk factors for discharge to care facility. Only the first 72 hours of intensive care were analyzed. Results— Approximately one-quarter of the survivors of CI were discharged to a care facility instead of to home (143/548, 26.1%). This event occurred more commonly in older patients, even after adjustment for severity of illness and comorbidities (odds ratio [OR] 1.8 for patients ≥ 65 years of age versus patients < 65 years; 95% confidence interval [CI] 1.1–3.1, p=0.02). The risk was greatest for patients who received mechanical ventilation (OR 3.4; 95% CI 2.0–5.8; p<0.001) or had hospitalizations characterized by severe cognitive dysfunction (OR 8.1; 95% CI 1.3–50.6; p=0.02) or poor strength and/or mobility (OR 31.7; 95% CI 6.4–157.3; p<0.001). The model showed good discrimination (area under Conclusion— Our model, which did not include baseline function or social variables, provided good discrimination between patients discharged to care facility following CI and patients discharged to home. These results suggest that future research should focus on the debilitating effects of respiratory failure and on conditions with cognitive and neuromuscular sequelae. we conducted a retrospective We performed a multivariable analysis and estimated the magnitude associated with We further hypothesized that the discrimination of the to changes in length of stay.

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