• Phillip D Levin, Theresa M Worner, Sigal Sviri, Sergey V Goodman, Yoram G Weiss, Sharon Einav, Charles Weissman, and Charles L Sprung.
• Department of Anesthesiology and Critical Care Medicine, Hadassah Hebrew University Hospital, Jerusalem, Israel.
• J Crit Care. 2003 Dec 1; 18 (4): 206-11.

ObjectiveTo assess the frequency, causes, and effect of unsuccessful discharge decisions from the ICU.SettingAn 11-bed general intensive care unit of a 750-bed urban university hospital, tertiary referral center and level one trauma center.DesignA prospective, observational study.PatientsAll ICU patients judged appropriate for discharge by the ICU attending physician.Measurements And ResultsA total of 856 attempted discharges in 706 patients were analyzed over 16 months. Of these, 703 (82%) were successful within 24 hours. Of the remaining 153 unsuccessful discharges, 51 (33%) were deferred because of medical deterioration, 32 (21%) at the request of the ward physicians or nurses and 70 (46%) because of administrative difficulties (lack of ward bed space or disagreement over admitting service). When compared to patients successfully discharged on the first attempt, those whose discharge was deferred had a significantly longer ICU admission prior to the first discharge attempt (median 4d v 3d, P =.009), and a higher proportion required intermediate care (48% v 26%, P <.001). Both these factors were independently associated with unsuccessful discharge in a logistic regression analysis (OR 1.04, 95%CI 1.02, 1.06, P =.0001, OR 2.05 95%CI 1.30, 3.26, P =.002, respectively). Deferred discharges accounted for 153 days of ICU care (2.6% of the total) and were associated with ICU overflow on 118 days (2% of all ICU days).ConclusionICU outflow limitation occurs in up to 1 in 6 discharges. It can be due to medical deterioration, level of care issues or administrative problems, and may lead to inefficient use of ICU resources.

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