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

Ravindranath Tiruvoipati, John Botha, Jason Fletcher, Himangsu Gangopadhyay, Mainak Majumdar, Sanjiv Vij, Eldho Paul, David Pilcher, Australia and New Zealand Intensive Care Society (ANZICS) Clinical Trials Group

Research output: Contribution to journalArticleResearchpeer-review

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.

Original languageEnglish
Article numbere0181827
JournalPLoS ONE
Volume12
Issue number7
DOIs
Publication statusPublished - 1 Jul 2017

Cite this

@article{79c235b769084a0ea677380083491392,
title = "Intensive care discharge delay is associated with increased hospital length of stay: A multicentre prospective observational study",
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.",
author = "Ravindranath Tiruvoipati and John Botha and Jason Fletcher and Himangsu Gangopadhyay and Mainak Majumdar and Sanjiv Vij and Eldho Paul and David Pilcher and {Australia and New Zealand Intensive Care Society (ANZICS) Clinical Trials Group} and Craig French and Colin McArthur and Sandra Peake and Rachael Parke and David Cooper and Andrew Udy and Glenn Eastwood",
year = "2017",
month = "7",
day = "1",
doi = "10.1371/journal.pone.0181827",
language = "English",
volume = "12",
journal = "PLoS ONE",
issn = "1932-6203",
publisher = "Public Library of Science",
number = "7",

}

Intensive care discharge delay is associated with increased hospital length of stay : A multicentre prospective observational study. / Tiruvoipati, Ravindranath; Botha, John; Fletcher, Jason; Gangopadhyay, Himangsu; Majumdar, Mainak; Vij, Sanjiv; Paul, Eldho; Pilcher, David; Australia and New Zealand Intensive Care Society (ANZICS) Clinical Trials Group.

In: PLoS ONE, Vol. 12, No. 7, e0181827, 01.07.2017.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Intensive care discharge delay is associated with increased hospital length of stay

T2 - A multicentre prospective observational study

AU - Tiruvoipati, Ravindranath

AU - Botha, John

AU - Fletcher, Jason

AU - Gangopadhyay, Himangsu

AU - Majumdar, Mainak

AU - Vij, Sanjiv

AU - Paul, Eldho

AU - Pilcher, David

AU - Australia and New Zealand Intensive Care Society (ANZICS) Clinical Trials Group

AU - French, Craig

AU - McArthur, Colin

AU - Peake, Sandra

AU - Parke, Rachael

AU - Cooper, David

AU - Udy, Andrew

AU - Eastwood, Glenn

PY - 2017/7/1

Y1 - 2017/7/1

N2 - 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.

AB - 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.

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U2 - 10.1371/journal.pone.0181827

DO - 10.1371/journal.pone.0181827

M3 - Article

VL - 12

JO - PLoS ONE

JF - PLoS ONE

SN - 1932-6203

IS - 7

M1 - e0181827

ER -