Direct Discharges from ICU/CCU

[BELCJ]

I'm looking for information on what the standard is regarding discharges home from ICU. It's been quite a few years since I worked there, and it used to be that if the patient was well enough to go home, then they didn't need to be in ICU. We were required to transfer to the Med/Surg unit prior to discharging home. It seems like things may have changed, but not sure if it is the physicians, or something else. Does anyone know if there is a guideline somewhere? What happens at your facilities?

We're a 10 bed ICU/CCU unit.

[nurse4theplanet, RN]

I have only seen one direct discharge home from ICU in the last year. It was a pt who had attempted suicide by drug OD. She was sent to ICU for 1-1 suicide precautions and close monitoring for reactions to drugs ingested. We kept her for 24 hours and they doc decided that given her specific situation and home support, it was best she was dc'd home with psych follow up than to be admitted to the psych floor or a psych hospital. She was medically cleared, so no need to go to med/surg or tele. Almost always, our cardiac pt's go to tele and our MSICU pts go to med-surg before being dc'd home.

[AmyCardsNP, RN, NP]

In my ICU, we routinely discharge our CEAs (carotids) home from ICU. By evening the day of surgery, or the next morning, the patient is ambulating, eating, and his/her pain is controlled by oral meds. So, unless there are any issues with the surgical site, blood pressure, neuro changes, or what have you, the patients are generally discharged by noon on post op day 1.

But, these are generally the only patients that we ever send directly home. I'm not sure if the trend you're seeing correlates to the increased awareness of hospital spending and the push to reduce the length of stay for all patients. That would be my guess though.

[BULLYDAWGRN, RN]

Heck our rinky-dinky icu has "same day d/c's", the doc's will amit a pt to use just for 12hrs of serial cardiac markers and then d/c if neg.

[nurse04girl]

we usually downgrade to tele and then transition out to medsurg. I have seen patients go home from tele. I have never seen anyone be d/c'd from ICU. I work at a small hospital. I don't like to d/c from tele.If a pt is d/c'd from ICU, good chance they didn't need to be ICU anyway.

[NRSKarenRN, BSN, RN]

One local CVICU discharges post CABG pts directly to home WITH homecare referral set up.

[TREBORICUNURSE]

first to medsurg then home. never from icu.

[LakotaRN]

We d/c to home CEA pt's postop day 1 directly from our CVICU, but have not seen other pt's d/c'd home from CVICU.

[bronzegoddess]

Our facility has no guidelines for discharging from icu directly. It really just depends on the patient and how sick they were. Insurance is not going to pay for more hospital days when they don't have to. Besides, our units see a lot of tele overflow because those floors are full, so of course we discharge tele overflow to home.