Objective: Day 0 intensive care unit (ICU) discharge allows to use one ICU bed for two patients. Results of this policy were analysed. Methods: From January 1998 to June 2001, 1194 patients who had myocardial revascularization in the morning were discharged on the same day (Group 0, n=647), or one (Group 1, n=521) or many days (Group 2, n=26) after surgery. Criteria for day 0 discharge were: early extubation with at least 2h of observation, stable hemodynamic status, no significant bleeding, no arrhythmias, normal EKG and normal neurological evolution. Results: Mean ICU stay was 4.0±1.2h in Group 0, 17.5±4.0h in Group 1 and 65.8±46.6h in Group 2 (P1, among Groups, <0.001; P2, between Groups 0 and 1, <0.001). In 613 cases (94.7% of patients in Group 0) the same ICU bed was used for another patient. Postoperative in-hospital stay was 4.1±2.3 d in Group 0, 4.9±3.1 d in Group 1 and 7.4±6.8 in Group 2 (P1<0.001; P2<0.001). Fifteen patients (1.2%) were readmitted to the ICU, seven in Group 0 (1.1%), five in Group 1 (1.0%) and three (11.5%) in Group 2 (P1<0.001, P2 n.s.), because of bleeding (five cases in Group 0, two in Group 1, none in Group 2; P1<0.001, P2), cerebrovascular accident (two cases in Group 0, none in Group 1, three in Group 2; P1<0.001, P2 n.s.), acute myocardial infarction (no case in Groups 0 and 2, two in Group 1; P1 n.s., P2 n.s.) and acute renal failure (no case in Group 0 and 2, one case in Group 1; P1 n.s., P2 n.s.). Nine patients (0.8%) died (three, 0.5%, in Group 0, three, 0.6%, in Group 1 and three, 11.5%, in Group 2; P1<0.001, P2 n.s.), four (one in Group 0, two in Group 1 and one in Group 2, P1 0.006, P2 n.s.) in the hospital (two from cardiac and two from non-cardiac causes) and five (two in Group 0, one in Group 1 and two in Group 2, P1<0.001, P2 n.s.) outside the hospital within the 30th day of surgery (one from cardiac and four from non-cardiac causes). No patient in Group 0 died from cardiac causes. Conclusions: Day 0 ICU discharge can be obtained in selected patients without an increased risk of death or of ICU readmission. The impact in terms of resource saving is striking. © 2002 Elsevier Science B.V. All rights reserved.
Day 0 intensive care unit discharge - Risk or benefit for the patient who undergoes myocardial revascularization?
Di Mauro M.;
2002-01-01
Abstract
Objective: Day 0 intensive care unit (ICU) discharge allows to use one ICU bed for two patients. Results of this policy were analysed. Methods: From January 1998 to June 2001, 1194 patients who had myocardial revascularization in the morning were discharged on the same day (Group 0, n=647), or one (Group 1, n=521) or many days (Group 2, n=26) after surgery. Criteria for day 0 discharge were: early extubation with at least 2h of observation, stable hemodynamic status, no significant bleeding, no arrhythmias, normal EKG and normal neurological evolution. Results: Mean ICU stay was 4.0±1.2h in Group 0, 17.5±4.0h in Group 1 and 65.8±46.6h in Group 2 (P1, among Groups, <0.001; P2, between Groups 0 and 1, <0.001). In 613 cases (94.7% of patients in Group 0) the same ICU bed was used for another patient. Postoperative in-hospital stay was 4.1±2.3 d in Group 0, 4.9±3.1 d in Group 1 and 7.4±6.8 in Group 2 (P1<0.001; P2<0.001). Fifteen patients (1.2%) were readmitted to the ICU, seven in Group 0 (1.1%), five in Group 1 (1.0%) and three (11.5%) in Group 2 (P1<0.001, P2 n.s.), because of bleeding (five cases in Group 0, two in Group 1, none in Group 2; P1<0.001, P2), cerebrovascular accident (two cases in Group 0, none in Group 1, three in Group 2; P1<0.001, P2 n.s.), acute myocardial infarction (no case in Groups 0 and 2, two in Group 1; P1 n.s., P2 n.s.) and acute renal failure (no case in Group 0 and 2, one case in Group 1; P1 n.s., P2 n.s.). Nine patients (0.8%) died (three, 0.5%, in Group 0, three, 0.6%, in Group 1 and three, 11.5%, in Group 2; P1<0.001, P2 n.s.), four (one in Group 0, two in Group 1 and one in Group 2, P1 0.006, P2 n.s.) in the hospital (two from cardiac and two from non-cardiac causes) and five (two in Group 0, one in Group 1 and two in Group 2, P1<0.001, P2 n.s.) outside the hospital within the 30th day of surgery (one from cardiac and four from non-cardiac causes). No patient in Group 0 died from cardiac causes. Conclusions: Day 0 ICU discharge can be obtained in selected patients without an increased risk of death or of ICU readmission. The impact in terms of resource saving is striking. © 2002 Elsevier Science B.V. All rights reserved.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
