Prolonging ICU stay reduces the number of ward deaths: evaluation of a model for triaging ICU discharges

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Introduction

A significant number of patients discharged alive from the intensive care unit (ICU) die subsequently on the general wards. A predictive model using data from the patients' last day in the ICU prior to discharge, and a 0.6 cutoff, correctly identified 66% of ward deaths. We tested the model's ability to identify those patients who may benefit from a further 24 to 48 h stay in ICU.

Patients and methods

All ICU survivors discharged between 1st June 1990 to 31st December 1996 who stayed for more than three days, in whom the predictive model applied within 48 h of ICU discharge, were studied. 562 patients were classified into three groups: Group (0) 311 patients last predicted to be at risk of ward death on the day of ICU discharge; Group (1) 188 patients last predicted at risk 24 h prior to ICU discharge; Group (2) 63 patients last predicted at risk 48 h prior to ICU discharge. The model was further evaluated using another two independent data sets.

Results

See Table. Similar findings were found for the two other data sets.

Conclusion

There was a significant improvement in hospital survival for those patients who stayed in the ICU an additional 48 h following the prediction of ward death. If this can be confirmed in a prospective study, it will have a major impact on the provision of ICU beds in the United Kingdom.

Table