Intensive Care Medicine

, Volume 31, Issue 12, pp 1676–1682 | Cite as

A nationwide survey of intensive care unit discharge practices

  • Claudia-Paula Heidegger
  • Miriam M. Treggiari
  • Jacques-André Romand
  • and the Swiss ICU Network



To describe intensive care unit (ICU) discharge practices, examine factors associated with physicians’ discharge decisions, and explore ICU and hospital characteristics and clinical determinants associated with the discharge process.


Survey in adult ICUs affiliated with the Swiss Society of Intensive Care Medicine.


Questionnaire inquiring about ICU structure and organization mailed to 73 medical directors. Level of monitoring, intravenous medications, and physiological variables were proposed as elements of discharge decision. Five clinical situations were presented with request to assign a discharge disposition.

Measurements and results

Fifty-five ICUs participated, representing 75% of adult Swiss ICUs. Responsibility for patient management was assigned in 91% to the ICU team directing patient care. Only 22% of responding centers used written discharge guidelines. One-half of the respondents considered at least 10 of 15 proposed criteria to decide patient discharge. ICUs in central referral hospitals used fewer criteria than community and private hospitals. The availability of intermediate care units was significantly greater in university hospitals. The ICU director’s level of experience was not associated with the number of criteria used. In the five clinical scenarios there was wide variation in discharge decision.


Our data indicate that there is marked heterogeneity in ICUs discharge practices, and that discharge decisions may be influenced by institutional factors. University teaching hospitals had more intermediate care facilities available. Written discharge guidelines were not widely used.


Intensive care unit Organization Questionnaire Critical care Human Practice guidelines 



The study was supported by the Swiss National Science Foundation Grant SCORE 3232-069341. The Swiss ICU Network Group participated in developing the study protocol and contributed to the present study. Members of the Swiss ICU Network are: P. Eckert, MD (Sion), H. Pargger, MD (Basel), M. Maggiorini, MD (Zürich), J.-P. Revelly, MD (Lausanne), J.-A. Romand, MD (Geneva), H.-U. Rothen MD (Berne). The authors wish to thank all the participating ICUs who devoted time for this survey questionnaire. The authors are also very grateful to Prof. Peter M. Suter for revising the manuscript and for his helpful suggestions.

Supplementary material

supp.pdf (166 kb)
(PDF 167 KB)


  1. 1.
    Groeger JS (1992) Descriptive analysis of critical care units in the United States. Crit Care Med 20:846–863PubMedGoogle Scholar
  2. 2.
    Moreno R, Agthe D (1999) ICU discharge decision-making: are we able to decrease post-ICU mortality? Intensive Care Med 25:1035–1036CrossRefPubMedGoogle Scholar
  3. 3.
    Moreno R, Matos R (2001) New issues in severity scoring: interfacing the ICU and evaluating it. Curr Opin Crit Care 7:469–474CrossRefPubMedGoogle Scholar
  4. 4.
    Daly K, Beale R, Chang RW (2001) Reduction in mortality after inappropriate early discharge from intensive care unit: logistic regression triage model. BMJ 322:1274–1276CrossRefPubMedGoogle Scholar
  5. 5.
    Brilli RJ, Spevetz A, Branson RD, Campbell GM, Cohen H, Dasta JF, Harvey MA, Kelley MA, Kelly KM, Rudis MI, St Andre AC, Stone JR, Teres D, Weled BJ (2001) Critical care delivery in the intensive care unit: defining clinical roles and the best practice model. Crit Care Med 29:2007–2019CrossRefPubMedGoogle Scholar
  6. 6.
    Baldock G, Foley P, Brett S (2001) The impact of organisational change on outcome in an intensive care unit in the United Kingdom. Intensive Care Med 27:865–872CrossRefPubMedGoogle Scholar
  7. 7.
    Carson SS, Stocking C, Podsadecki T, Christenson J, Pohlman A, MacRae S, Jordan J, Humphrey H, Siegler M, Hall J (1996) Effects of organizational change in the medical intensive care unit of a teaching hospital: a comparison of ‘open’ and ‘closed’ formats. JAMA 276:322–328CrossRefPubMedGoogle Scholar
  8. 8.
    Carlson RW, Weiland DE, Srivathsan K (1996) Does a full-time, 24-hour intensivist improve care and efficiency? Crit Care Clin 12:525–551CrossRefPubMedGoogle Scholar
  9. 9.
    Byrick RJ, Mazer CD, Caskennette GM (1993) Closure of an intermediate care unit. Impact on critical care utilization. Chest 104:876–881PubMedGoogle Scholar
  10. 10.
    Task Force of the American College of Critical Care Medicine, Society of Critical Care Medicine (1999) Guidelines for intensive care unit admission, discharge, and triage. Crit Care Med 27:633–638PubMedGoogle Scholar
  11. 11.
    Azoulay E, Adrie C, De Lassence A, Pochard F, Moreau D, Thiery G, Cheval C, Moine P, Garrouste-Orgeas M, Alberti C, Cohen Y, Timsit JF (2003) Determinants of postintensive care unit mortality: a prospective multicenter study. Crit Care Med 31:428–432CrossRefPubMedGoogle Scholar
  12. 12.
    Pilkington SN, McQuillan PJ, Smith GB, Taylor B (1995) APACHE scoring and prediction of survival in intensive care. BMJ 310:1197Google Scholar
  13. 13.
    Cooper GS, Sirio CA, Rotondi AJ, Shepardson LB, Rosenthal GE (1999) Are readmissions to the intensive care unit a useful measure of hospital performance? Med Care 37:399–408CrossRefPubMedGoogle Scholar
  14. 14.
    Franklin C, Jackson D (1983) Discharge decision-making in a medical ICU: characteristics of unexpected readmissions. Crit Care Med 11:61–66PubMedGoogle Scholar
  15. 15.
    Rubins HB, Moskowitz MA (1988) Discharge decision-making in a medical intensive care unit. Identifying patients at high risk of unexpected death or unit readmission. Am J Med 84:863–869CrossRefPubMedGoogle Scholar
  16. 16.
    Rosenberg AL, Hofer TP, Hayward RA, Strachan C, Watts CM (2001) Who bounces back? Physiologic and other predictors of intensive care unit readmission. Crit Care Med 29:511–518CrossRefPubMedGoogle Scholar
  17. 17.
    Metnitz PG, Fieux F, Jordan B, Lang T, Moreno R, Le Gall JR (2003) Critically ill patients readmitted to intensive care units-lessons to learn? Intensive Care Med 29:241–248PubMedGoogle Scholar
  18. 18.
    Iapichino G, Morabito A, Mistraletti G, Ferla L, Radrizzani D, Reis Miranda D (2003) Determinants of post-intensive care mortality in high-level treated critically ill patients. Intensive Care Med 29:1751–1756CrossRefPubMedGoogle Scholar
  19. 19.
    Beck DH, McQuillan P, Smith GB (2002) Waiting for the break of dawn? The effects of discharge time, discharge TISS scores and discharge facility on hospital mortality after intensive care. Intensive Care Med 28:1287–1293CrossRefPubMedGoogle Scholar
  20. 20.
    Metnitz PG, Reiter A, Jordan B, Lang T (2004) More interventions do not necessarily improve outcome in critically ill patients. Intensive Care Med 30:1586–1593CrossRefPubMedGoogle Scholar
  21. 21.
    Goldhill DR, Sumner A (1998) APACHE II, data accuracy and outcome prediction. Anaesthesia 53:937–943CrossRefPubMedGoogle Scholar
  22. 22.
    Nasraway SA, Cohen IL, Dennis RC, Howenstein MA, Nikas DK, Warren J, Wedel SK (1998) Guidelines on admission and discharge for adult intermediate care units. American College of Critical Care Medicine of the Society of Critical Care Medicine. Crit Care Med 26:607–610CrossRefPubMedGoogle Scholar
  23. 23.
    Goldfrad C, Rowan K (2000) Consequences of discharges from intensive care at night. Lancet 355:1138–1142CrossRefPubMedGoogle Scholar
  24. 24.
    Bion J (1995) Rationing intensive care. BMJ 310:682–683PubMedGoogle Scholar
  25. 25.
    Wallis CB, Davies HT, Shearer AJ (1997) Why do patients die on general wards after discharge from intensive care units? Anaesthesia 52:9–14CrossRefPubMedGoogle Scholar
  26. 26.
    Eddleston JM, White P, Guthrie E (2000) Survival, morbidity, and quality of life after discharge from intensive care. Crit Care Med 28:2293–2299CrossRefPubMedGoogle Scholar
  27. 27.
    Lemeshow S, Teres D, Klar J, Avrunin JS, Gehlbach SH, Rapoport J (1993) Mortality Probability Models (MPM II) based on an international cohort of intensive care unit patients. JAMA 270:2478–2486CrossRefPubMedGoogle Scholar
  28. 28.
    Ball C, Kirkby M, Williams S (2003) Effect of the critical care outreach team on patient survival to discharge from hospital and readmission to critical care: non-randomised population based study. BMJ 327:1014CrossRefPubMedGoogle Scholar
  29. 29.
    Priestley G, Watson W, Rashidian A, Mozley C, Russell D, Wilson J, Cope J, Hart D, Kay D, Cowley K, Pateraki J (2004) Introducing Critical Care Outreach: a ward-randomised trial of phased introduction in a general hospital. Intensive Care Med 30:1398–1404CrossRefPubMedGoogle Scholar
  30. 30.
    Pronovost PJ, Angus DC, Dorman T, Robinson KA, Dremsizov TT, Young TL (2002) Physician staffing patterns and clinical outcomes in critically ill patients: a systematic review. JAMA 288:2151–2162CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • Claudia-Paula Heidegger
    • 1
  • Miriam M. Treggiari
    • 1
  • Jacques-André Romand
    • 1
  • and the Swiss ICU Network
  1. 1.Division of Surgical Intensive CareUniversity HospitalGeneva 14Switzerland

Personalised recommendations