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CHEST: More ICU Patients Discharged Directly to Home

Teaching hospitals show higher mortality rate for emergency acute respiratory failure admissions

WEDNESDAY, Nov. 4 (HealthDay News) -- An increasing number of intensive care unit patients are being discharged directly to home. In addition, mortality is higher among patients with acute respiratory failure who are admitted to teaching hospitals, according to research presented at the 75th annual international scientific assembly of the American College of Chest Physicians, held from Oct. 31 to Nov. 5 in San Diego.

In one study, Ashraf Rashid, M.D., of the Memorial Sloan-Kettering Cancer Center in New York City, and colleagues analyzed 2004 to 2008 data on discharged intensive care patients, including 33 (1.4 percent) who were discharged to home instead of a step-down unit. They found that home discharges occurred with increasing frequency during years two through four of the study, and that six-month mortality in home discharges -- 20 of whom had incurable or inoperable malignancies -- was 36.4 percent.

In a second study, Yen-Hong Kuo, of the Jersey Shore University Medical Center in Neptune, N.J., and colleagues used the U.S. Nationwide Inpatient Sample database to review 82,121 emergency admissions for acute respiratory failure, of which 40.3 percent were to teaching hospitals. They found the mortality rate was significantly higher among admissions to teaching hospitals (25.4 versus 23.6 percent).

"While invasive support was minimal, the admitting diagnoses and severity of illness were typical of intensive care unit patients," Rashid and colleagues conclude. "Further studies are needed to better define who could be discharged home."

Abstract - Rashid
Abstract - Kuo
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