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Invited Commentary
October 2018

The Complexity and Challenges of Intensive Care Unit Admissions and Discharges: Similarities With All Hospitalized Patients

Author Affiliations
  • 1Massachusetts General Hospital, Boston, Massachusetts
JAMA Intern Med. 2018;178(10):1399-1400. doi:10.1001/jamainternmed.2018.3674

Patients admitted to the intensive care unit (ICU) are heterogeneous in their underlying illnesses, comorbidities, and requirements for either invasive or nearly continuous monitoring of physiologic and laboratory values. There is also variance in their need for mechanical ventilation, renal replacement therapy, and other mechanical support. Given this heterogeneity, it has been difficult to make broad conclusions about “critically ill” patients.

In this issue of JAMA Internal Medicine, Stelfox and colleagues1 report that more than 1 in 10 adult patients treated in a medical-surgical ICU are sent home directly from the ICU without experiencing an increase in health care utilization or worse outcomes compared with those first transferred to a hospital general care unit prior to discharge home. These results suggest that there are groups of patients who may require less monitoring and support. Early recognition of this patient group and establishment of alternative pathways to ICU admission might decrease ICU utilization and the cost of hospitalization. On the other hand, it is possible that the ICU is appropriate for a subset of patients through their entire stay, and then they are appropriately discharged directly home as soon as they are ready for transfer out of the ICU. Early identification of this group based on patient characteristics and disease characteristics may help the ICU team prospectively prepare the patient and family for transition to home from the outset of ICU admission.

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