A semiquantitative assessment of the effects of delayed discharge from the intensive care unit of survivors of critical illness

Introduction

One consequence of pressure on inpatient hospital bed numbers is a delay in the discharge of critically ill patients to the ward. Although this delay in discharge has been reported in a number of countries, the clinical and economic consequences of this delay have not been studied [1, 2].

Methods

We examined data from a mixed London ICU (32 beds) using the medtrack software tool (MASH Ltd) in addition to real-time mapping of ICU bed utilisation and patient flows. We defined delayed discharge as beginning 3 hours after the actual medical/nursing decision to discharge. We described a set of criteria a priori, to assess the effect of delayed patient discharge, searching for both beneficial and harmful effects. We also analysed the economic consequences of discharge delay using the medtrack capture of the critical care minimum dataset and available tariffs.

Results

In the 6-month analysis period, there were 15,320 hours of delayed discharge. This resulted in the postponement/delay of 45 operations for patients requiring level 3 intensive care and 177 operations for patients requiring level 2 intensive care. One hundred and fourteen tertiary referrals were refused because of bed blockage. Seventy-two patients were discharged between the hours of 22:00 and 06:00. There was a mean delay of 5.3 hours between identifying a patient requiring unplanned admission to critical care and their actual admission due to delayed discharge. Only 21 patients acquired a hospital-acquired organism while awaiting discharge (seven infections). Family/patient interviews suggested that the negative effects of noise and exposure to the resuscitation and/or death of ICU patients were off set by a perceived benefit of receiving critical care nursing for a prolonged period. This potential benefit was reflected by a 72% reduction in the readmission of critically ill patients to critical care. The estimated cost of delayed discharge was £342,000.

Conclusions

Delayed discharge of patients to the ward following an episode of critical illness is a common and increasing problem. This delay is not benign and should be considered when prioritising bed utilisation in acute hospitals.