In Reply We thank Roshdy and colleagues for sharing their local experiences with the discharge of patients directly home from the intensive care unit (ICU). Their data complements those published in our study and others highlighting that flow failure, the inefficient movement of patients across the health care system, is a growing global problem with ramifications that extend to the care of critically ill patients.1 Delays in patient discharge from the ICU have risks. Resources may be misallocated, and non-ICU related treatments may be deferred.2 Communication may fail because physicians primarily communicate when patients are ready for discharge and not when they actually move.2 Strategies are clearly needed to minimize transfer delays, ensure patient care continues while awaiting transfer, and that information is updated and communication repeated at the time of transfer.3
Stelfox HT, Niven DJ, Fiest KM. Discharge Home From Critical Care: Comparing Different Healthcare Systems—Reply. JAMA Intern Med. 2018;178(12):1729–1730. doi:10.1001/jamainternmed.2018.6548
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