Factors Associated With Discharge Home Among Medical ICU Patients in an Early Mobilization Program

Roger Y Kim, Terrence E Murphy, Margaret Doyle, Catherine Pulaski, Maura Singh, Sui Tsang, Dawn Wicker, Margaret A Pisani, Geoffrey R Connors, Lauren E Ferrante, Roger Y Kim, Terrence E Murphy, Margaret Doyle, Catherine Pulaski, Maura Singh, Sui Tsang, Dawn Wicker, Margaret A Pisani, Geoffrey R Connors, Lauren E Ferrante

Abstract

Objectives: One goal of early mobilization programs is to facilitate discharge home after an ICU hospitalization, but little is known about which factors are associated with this outcome. Our objective was to evaluate factors associated with discharge home among medical ICU patients in an early mobilization program who were admitted to the hospital from home.

Design: Retrospective cohort study of medical ICU patients in an early mobilization program.

Setting: Tertiary care center medical ICU.

Patients: Medical ICU patients receiving early mobilization who were community-dwelling prior to admission.

Interventions: None.

Measurements and main results: A comprehensive set of baseline, ICU-related, and mobilization-related factors were tested for their association with discharge home using multivariable logistic regression. Among the analytic cohort (n = 183), the mean age was 61.9 years (sd 16.67 yr) and the mean Acute Physiology and Chronic Health Evaluation II score was 23.5 (sd 7.11). Overall, 65.0% of patients were discharged home after their critical illness. In multivariable analysis, each incremental increase in the maximum level of mobility achieved (range, 1-6) during the medical ICU stay was associated with nearly a 50% greater odds of discharge home (odds ratio, 1.46; 95% CI, 1.13-1.88), whereas increased age (odds ratio, 0.95; 95% CI, 0.93-0.98) and greater hospital length of stay (odds ratio, 0.94; 95% CI, 0.90-0.99) were associated with decreased odds of discharge home. Prehospital ambulatory status was not associated with discharge home.

Conclusions: Among medical ICU patients who resided at home prior to their ICU admission, the maximum level of mobility achieved in the medical ICU was the factor most strongly associated with discharge back home. Identification of this factor upon ICU-to-ward transfer may help target mobilization plans on the ward to facilitate a goal of discharge home.

Keywords: critical care; critical care outcomes; early mobilization; patient discharge; physical and rehabilitation medicine.

Copyright © 2019 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine.

Figures

Figure 1.
Figure 1.
Assembly of the analytic sample from the parent cohorts. All medical ICU (MICU) admissions during initial implementation of an early mobilization program (March 26, 2015, to June 30, 2015) and 1 yr later (March 26, 2016, to June 30, 2016) were identified. After confirming there were no statistically significant differences between these two patient cohorts, a combined cohort was established. Patients with goals of comfort measures only, discharge to hospice, excessively long length of stay (LOS) (MICU > 21 d or hospital > 45 d), or history of limb amputation were excluded. The first hospitalization per patient per year was selected, and for patients with multiple ICU admissions within a single hospital stay, data were included from all MICU stays. We then selected patients admitted to the hospital from home. The analytic sample included 183 MICU admissions. SNF = skilled nursing facility.
Figure 2.
Figure 2.
Percent of discharges home by level of maximum mobility in the medical ICU (MICU). The maximum levels of mobility in the MICU are as follows: 1—therapeutic (in-bed) exercises, 2—bed mobility (supine-to-sit), 3—transfer training (sit-to-stand/bed-to-chair), 4—gait training (

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