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Meta-Analysis
. 2023 Jan 1;51(1):127-135.
doi: 10.1097/CCM.0000000000005720. Epub 2022 Nov 9.

Safety Outcomes of Direct Discharge Home From ICUs: An Updated Systematic Review and Meta-Analysis (Direct From ICU Sent Home Study)

Vincent I Lau  1 , Ryan Donnelly  2 , Sehar Parvez  2 , Jivanjot Gill  2 , Sean M Bagshaw  1 , Ian M Ball  3   4 , John Basmaji  3 , Deborah J Cook  5   6 , Kirsten M Fiest  7 , Robert A Fowler  8   9 , Jonathan F Mailman  2   10   11 , Claudio M Martin  3 , Bram Rochwerg  5   6 , Damon C Scales  8   9 , Henry T Stelfox  7 , Alla Iansavichene  12 , Eric J Sy  7
Affiliations
Meta-Analysis

Safety Outcomes of Direct Discharge Home From ICUs: An Updated Systematic Review and Meta-Analysis (Direct From ICU Sent Home Study)

Vincent I Lau et al. Crit Care Med. .

Abstract

Objective: To evaluate the impact of direct discharge home (DDH) from ICUs compared with ward transfer on safety outcomes of readmissions, emergency department (ED) visits, and mortality.

Data sources: We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Cumulative Index to Nursing and Allied Health Literature from inception until March 28, 2022.

Study selection: Randomized and nonrandomized studies of DDH patients compared with ward transfer were eligible.

Data extraction: We screened and extracted studies independently and in duplicate. We assessed risk of bias using the Newcastle-Ottawa Scale for observational studies. A random-effects meta-analysis model and heterogeneity assessment was performed using pooled data (inverse variance) for propensity-matched and unadjusted cohorts. We assessed the overall certainty of evidence for each outcome using the Grading Recommendations Assessment, Development and Evaluation approach.

Data synthesis: Of 10,228 citations identified, we included six studies. Of these, three high-quality studies, which enrolled 49,376 patients in propensity-matched cohorts, could be pooled using meta-analysis. For DDH from ICU, compared with ward transfers, there was no difference in the risk of ED visits at 30-day (22.4% vs 22.7%; relative risk [RR], 0.99; 95% CI, 0.95-1.02; p = 0.39; low certainty); hospital readmissions at 30-day (9.8% vs 9.6%; RR, 1.02; 95% CI, 0.91-1.15; p = 0.71; very low-to-low certainty); or 90-day mortality (2.8% vs 2.6%; RR, 1.06; 95% CI, 0.95-1.18; p = 0.29; very low-to-low certainty). There were no important differences in the unmatched cohorts or across subgroup analyses.

Conclusions: Very low-to-low certainty evidence from observational studies suggests that DDH from ICU may have no difference in safety outcomes compared with ward transfer of selected ICU patients. In the future, this research question could be further examined by randomized control trials to provide higher certainty data.

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Conflict of interest statement

Dr. Parvez received funding from the University of Saskatchewan College of Medicine Dean’s Summer Student 2020 Award. Dr. Bagshaw received funding from Baxter and BioPorto. Dr. Scales’ institution received funding from the Canadian Institute for Health Research. Dr. Sy received funding from the Saskatchewan Health Research Foundation Establishment Grant. Dr. Bagshaw is supported by a Canada Research Chair in Critical Care Outcomes and Systems Evaluation. Dr. Fowler is the H. Barrie Fairley Professor of Critical Care Medicine at the University Health Network and the Interdepartmental Division of Critical Care Medicine at the University of Toronto. The remaining authors have disclosed that they do not have any potential conflicts of interest.

Figures

Figure 1.
Figure 1.
Direct From ICU Sent Home Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram.
Figure 2.
Figure 2.
Forest plot of emergency department (ED) visits, hospital readmission, and mortality ED visits at closest to 30 d (A), hospital readmission at closest to 30 d (B), and mortality at closest to 90 d (propensity-matched cohorts) (C).
See this image and copyright information in PMC

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References

    1. Lau VI, Priestap FA, Lam JNH, et al. : Factors associated with the increasing rates of discharges directly home from intensive care units—a direct from ICU sent home study. J Intensive Care Med. 2016; 33:121–127 - PubMed
    1. Stelfox HT, Soo A, Niven DJ, et al. : Assessment of the safety of discharging select patients directly home from the intensive care unit: A multicenter population-based cohort study. JAMA Intern Med. 2018; 178:1390–1399 - PMC - PubMed
    1. Lau VI, Lam JNH, Basmaji J, et al. : Survival and safety outcomes of ICU patients discharged directly home—a direct from ICU sent home study*. Crit Care Med. 2018; 46:900–906 - PubMed
    1. Martin CM, Lam M, Allen B, et al. : Determinants of direct discharge home from critical care units: A population-based cohort analysis. Crit Care Med. 2019; 48:475–483 - PubMed
    1. Martin CM, Lam M, Le B, et al. : Outcomes after direct discharge home from critical care units: A population-based cohort analysis. Crit Care Med. 2022; 50:1256–1264 - PubMed