A Cardiac Surgery ICU Discharge Model; for Research and Logistic Purpose

ABSTRACT

Length of stay in the ICU is one of the factors limiting operating room utilization in cardiac surgery and consequently one of the primary cost-effectiveness parameters. At present it seems that factors guiding LOS in ICU after cardiac surgery has reached a stage, where the need for patient turnover, practical convenience and especially local policies are superior to what is actually possible and even many different recovery scores have been used and refined following new monitoring techniques length of stay is not a valid parameter when comparing institutions or procedures. ICU research and quality programmes are needed to make goal-oriented programmes. The purpose of this prospective study was to create an objective and reproducible ICU discharge model to be used in research and as an administrative logistic tool in cardiac surgery.

Patients and methods: All cardiac patients in a 50 day period (N=113) were followed. Our discharge model consists of 5 semi-objective variables (sedation, respiration, nausea, pain and motor function and 7 objective variables (peripheral saturation, diureses, arterial blood pressure, heart rate, cardiac index, temperature and postoperative drainage). Patients were score every hour until the next morning, termination of haemodynamic monitoring or at discharge, whichever came first. Patients were considered eligible for discharge from the cardiac recovery unit at a steady discharge score of 4 (IDS4) or below and with no single variable score higher than 2.

Results: The actual discharge time was statistically significant longer than the eligible discharge time (p<0.0001), with a difference of 8.68 hours. The data showed no correlation between ventilation time and eligible time to discharge, while in actual discharge time patients ventilated shorter time also presented the shortest time to actual discharge.

Conclusion: Although very early extubation has impact on actual discharge time from ICU, it does not favour a shorter time to reach an eligible state. The perplexity of definitions in relation to LOS in ICU calls for an evaluation protocol and the described objective discharge model might be valuable, especially with respect to research, but also for logistic and administrative purposes. The relative objectivity makes comparison between units and centres more reliable than present reporting.