Survivors of catastrophic illness: Outcome after direct transfer from intensive care to extended care facilities

Objective: To describe outcomes of adult survivors of prolonged critical il lness after direct transfer to extended care facilities, Design: A retrospective cohort study. Setting: All adult intensive care units (ICUs) in a tertiary care universit y hospital. Patients: A consecutive series of 97 adult survivors with an ICU stay of gr eater than or equal to 7 days transferred directly from intensive care to e xtended care facilities between 1990 and 1996, Interventions: None. Methods and Main Results: Hospital and extended care facility charts were r eviewed for patient characteristics, resource utilization, and survival. Su rvivors were for a minimum of 1 yr and a maximum of 6 yrs, and were intervi ewed to assess quality of life and functionality. The mean age of the patie nts was 66 +/- 16 (range, 19-93) yrs, The median length of ICU stay for the se patients was 39 (range, 7-276) days. Only 18 of the 71 ventilator-assist ed patients were weaned from mechanical ventilation after transfer to the e xtended care facility, Survival for the study period, at 1 yr after dischar ge from the ICU, was 49.5%, One year after discharge from the ICU, 11.5% of all patients had returned home, were breathing spontaneously, had a fair o r better quality of life, and had good physical functionality. Each success ive year, an increasing proportion of patients underwent direct transfer to an extended care facility. This strategy decreased the patients' length of stay (p < .002) in the ICU from year to year, but was significantly associ ated with an increase in readmissions to acute care hospitals (p < ,002), Conclusions: Survivors of catastrophic illness who are so debilitated that they require transfer to an extended care facility have a low likelihood of achieving both survival and functional independence 1 yr after discharge f rom the ICU, Aggressive cost-conscious strategies to accelerate the transfe r of these patients successfully reduced the length of ICU stay and hospita l costs, but were associated with a high rate of readmission to tertiary ca re facilities.