Long term acute care hospitals (LTACHs) can continue the care for high risk patients who are deemed medically stable to leave an ICU. Little is known about the type and frequency of discharge destinations from LTACHs. Factors such as age, prior debility and number of comorbidities are significantly associated with survival to discharge from LTACHs. We sought to understand the factors associated with a favorable discharge outcome, beyond survival.
A prospective, observational medical record review and survey. Inclusion criteria: ICU patients with principal diagnosis of respiratory insufficiency or failure, referred to the Emory LTACH pulmonary service for ventilator and tracheostomy weaning. Exclusion criteria: prior admission to LTACH. A favorable outcome was defined as any discharge destination other than re-admission to an acute care hospital, hospice or death.
62 patients enrolled. Mean age: 60.5 +/- 16.3 years; 51.6% female; 53.2% non-white race; 27.4% active smokers. ICU indications were as follows: 29.0% CNS disease; 19.3% post-operative; 16.1% acute lung injury; 12.9% MSOF; 9.7% cardiac disease; 6.5% chronic lung disease; 6.5% other. The distribution of discharge destinations was as follows: 27.4% acute rehabilitation facility; 25.8% readmission to acute care hospital ICU; 22.6% subacute rehabilitation facility; 14.5% home; 6.5% died; 3.2% nursing home. See table.
Most (68%) patients in our study experienced a favorable discharge outcome. Younger age, more education, history of prior independence and absence of renal disease were all statistically significant factors associated with a favorable discharge outcome. Lower initial ICU albumin; lower initial LTACH albumin and lower initial LTACH hemoglobin; and higher initial LTACH creatinine were all significantly associated with unfavorable discharge outcomes. A significant minority of patients (26%) required re-admission to the acute care hospital ICU.
Most patients experienced a favorable LTACH discharge outcome. Factors associated with favorable ICU outcomes (age, history of renal disease, albumin, creatinine, hemoglobin) are also associated with favorable LTACH outcomes in our study. More research is needed to determine what factors within the LTACH course can improve patient outcomes.
FactorFavorable (N = 42)Unfavorable (N = 20)p ValueDemographicsmean age –years56.3± 15.469.3± 14.80.0023High school graduate36 (86%)11 (55%)0.0411Female gender22 (52%)10 (50%)0.8608White race22 (52%)7 (35%)0.1998Never smoker18 (43%)5 (25%)0.1736Past Medical HistoryPrior independence31 (74%)9 (45%)0.0441History of renal disease7 (17%)8 (40%)0.0449ICU day onealbumin (g/dL) –mean2.80± 0.852.31± 0.580.0296creatinine (mg/dL) –median0.951.30.0502hemoglobin (g/dL) –median12.111.750.2802ICU LOS (days) –median30270.133LTACH day onealbumin (g/dL) –mean2.37 +/- 0.52.03 +/- 0.50.0125creatinine (mg/dL) –median0.751.00.0320hemoglobin (g/dL) –median10.759.90.0157LTACH LOS (days) –median24130.010
Linda Wolfenden, None.