• Preeyal M Patel, Michele A Fiorella, Ann Zheng, Lauren McDonnell, Mina Yasuoka, and Erika J Yoo.
• Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.
• J Intensive Care Med. 2021 Dec 1; 36 (12): 1431-1435.

ObjectiveTo evaluate the safety of directly discharging patients home from the medical intensive care unit (MICU).Materials And MethodsSingle-center retrospective observational study of consecutive MICU direct discharges to home from an urban university hospital between June, 1, 2017, and June 30, 2019.ResultsOf 1061 MICU discharges, 331 (31.2%) patients were eligible for analysis. Patients were divided into 2 groups based on duration of wait-time (< or ≥24 hours) between ward transfer order and ultimate hospital discharge. Most patients (68.2%) were discharged in <24 hours. Patients who waited for a floor bed for ≥24 hours prior to discharge had longer hospital length-of-stay (LOS, median 3.83 versus 2.00 days) and ICU LOS (median 3.51 versus 1.74 days). Overall, 44 (13.3%) direct MICU discharges were readmitted to the hospital within 30-days, but there was no difference in this outcome or in 30-day mortality when comparing the 2 wait-time groups.ConclusionsThe practice of directly discharging MICU patients home does not negatively influence patient outcomes. Patients who overstay in the ICU after being deemed transfer-ready are unlikely to be benefiting from critical care, but impact hospital throughput and resource utilization. Prospective investigation into this practice may provide further confirmation of its feasibility and safety.

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