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Original Research: CRITICAL CARE MEDICINE |

ICU Admissions After Actual or Planned Hospital Discharge: Incidence, Clinical Characteristics, and Outcomes in Patients With Cancer

Sanjay Chawla, MD, FCCP; Stephen M. Pastores, MD, FCCP; Kashif Hassan, MD; Nina D. Raoof, MD, FCCP; Louis P. Voigt, MD, FCCP; Margarita Alicea, RN; Neil A. Halpern, MD, FCCP
Author and Funding Information

Affiliations: From the Critical Care Medicine Service, Department of Anesthesiology and Critical Care Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY.

Correspondence to: Sanjay Chawla, MD, FCCP, Assistant Attending, Critical Care Medicine Service, Department of Anesthesiology and Critical Care Medicine, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, C1179, New York, NY 10065; e-mail: chawlas@mskcc.org


Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).


© 2009 American College of Chest Physicians


Chest. 2009;136(5):1257-1262. doi:10.1378/chest.08-2909
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Background:  Unexpected ICU admissions may result from early or premature discharge from the hospital. We sought to determine the incidence, clinical characteristics, and outcomes of patients admitted to the ICU after actual or planned hospital discharge and to analyze whether the need for ICU admission was related or unrelated to the associated hospitalization.

Methods:  We retrospectively reviewed all adult ICU admissions between January 2004 and December 2006 at a tertiary care cancer center and identified the following two groups of patients: those patients admitted directly to the ICU within 48 h of actual hospital discharge (group A); and those patients admitted to the ICU within 48 h of planned hospital discharge (group B).

Results:  Of 60,462 patients discharged from the hospital during the study period, 826 patients (1.4%) required readmission to the hospital within 48 h of discharge; of these, 13 patients (1.5%) were admitted directly to the ICU (group A). An additional 12 patients were admitted to the ICU within 48 h of a planned hospital discharge (group B). The majority of these 25 patients (68%) [groups A and B] required ICU admission for a condition that was related to the previous or current hospitalization. The overall hospital mortality rate for both groups was 16%.

Conclusions:  A small, but unique group of patients is admitted to the ICU within 48 h of actual or planned hospital discharge. Worsening of the underlying condition that necessitated the previous or current hospitalization often is the reason for ICU admission. Whether ICU admission could have been prevented by continued hospital care or improved diagnostic evaluation during the prior or current hospitalization requires further study.

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