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Over a third of deaths after discharge from intensive care are preventable

Reduction in mortality after inappropriate early discharge from intensive care unit: logistic regression triage model

Death after discharge from intensive care may be reduced by 39% if at risk patients were to stay in intensive care for another 48 hours, finds a study in this week's BMJ.

Data from nearly 14,000 patients who were discharged from 20 UK intensive care units from 1989 to 1998 were used to develop a predictive model to identify those most at risk from inappropriate early discharge. Thirty-four per cent of patients were identified as at risk and had a discharge mortality of 25% compared with a 4% mortality among those not at risk.

The researchers calculated that, if these patients were to stay in intensive care for another two days, mortality after discharge could be reduced by 39%, although this would require an estimated 16% more intensive care beds.

The model may help doctors to make the difficult clinical decision of whom to discharge to make room for a patient requiring urgent admission to the unit, say the authors. However, neither this, nor discharge guidelines published by the Department of Health in 1996, will have much impact until and unless the shortfall in provision of intensive care beds is corrected, they conclude.

Contact:

R W S Chang, Consultant Transplant Surgeon, St George's Hospital, London, UK Email: renechang@compuserve.com

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