Discharge policies in ICU

[ahv5457]

Dear all,

I am Ali, I am a PhD student in operations management. I am working on the optimal discharge policies from ICU. In literature, briefly, patients can be discharged based on the following policies:

1. Mortality risk

2. Congestion

3. Readmission risk

4. Probability of readmission, or maybe

5. random

I would like to know if any of these policies are being used by the ICU's doctor to discharge a patient or he/she decides only based on his/her experience. Also, there are some other priority scores such as APACHES, which prioritize patients based on their risks.

Could you please let me know what happens in the real practice? Do doctors use these policies to discharge patients at all?

Regards,

Ali

[Ruby Vee, BSN]

We rarely discharge patients from ICU. We transfer them to a less acute level of care such as an IMC or step-down unit.

[Esme12, ASN, BSN, RN]

Predictive scoring systems have been developed to measure the severity of disease and the prognosis of patients in the intensive care unit (ICU). Such measurements are helpful for clinical decision making, standardizing research, and comparing the quality of patient care across ICUs. In the US it is used only of a predictor of mortality and not used as an admission/discharge/treatment criteria and is used by physicians.

As per hospital policy admission and discharge criteria (meaning discharge from the unit to another floor) is set by the nursing/medical staff and hospital policy. Certain meds cannot not be on the floor even if the patient it stable. Certain equipment isn't allowed on certain floors unless the patient is a DNR. They state specifics like vitals signs stable with a mean arterial pressure of 60. No vasoactive drips unless on a monitored unit and are maintenance and not titration. Patient must have stable airway. The floors also have discharge/admission criteria. Patient must have stable vital signs. B/P must be with in certain range. No vasoavtice drips unless DNR....etc.

The Apache-II Score provides an estimate of ICU mortality based on a number of laboratory values and patient signs taking both acute and chronic disease into account. Note: The data used should be from the initial 24 hours in the ICU, and the worst value (furtherest from baseline/normal) should be used.

The following defines "chronic organ insufficiency" and immunocompromise:

• Liver insufficiency
  
  • Biopsy proven cirrhosis
    
  • Documented portal hypertension
    
  • Episodes of past upper GI bleeding attributed to portal hypertension
    
  • Prior episodes of hepatic failure / encephalopathy / coma.
    

  [*]Cardiovascular

  • New Heart Association Class IV Heart Failure
    

  [*]Respiratory

  • Chronic restrictive, obstructive or vascular disease resulting in severe exercice restriction, i.e. unable to climb stairs or perform household duties.
    
  • Documented chronic hypoxia, hypercapnia, secondary polycythemia , severe pulmonary hypertension (> 40 mmHg), or respirator dependency.
    

  [*]Renal

  • Receiving chronic dialysis
    

  [*]Immunosuppression

  • The patient has received therapy that suppresses resistance to infection e.g. immuno-suppression, chemotherapy, radiation, long term or recent hight dose steroids, or has a disease that is sufficiently advanced to suppress resistance to infection, e.g. leukemia, lymphoma, AIDS.
    

APACHE II Score | MDCalc