Direct Discharge Home from the Intensive Care Unit: A Modern Necessity?
Location
Hager-Lubbers Exhibition Hall
Description
PURPOSE: Decrease delay of transfer from the Intensive Care Unit (ICU) (in days) for patients with Diabetic Ketoacidosis (DKA) by implementing Direct Discharge Home (DDH) from the ICU. Facilitating safe transitions of care between healthcare settings and demonstrating stewardship of limited health care resources are key competencies for the Clinical Nurse Leader (CNL). CHALLENGE: Hospital overcrowding results in transfer delays from the ICU to lower levels of care. Delays may span several days, during which patients improve clinically and become discharge ready. This reality supports DDH from the ICU out of necessity. Evidence demonstrates this trend is not unique to this hospital but is an emerging trend in the healthcare industry overall.EXPERIENCE: This CNL immersion experience took place over two semesters in the ICU of a 240-bed acute care urban hospital in mid-Michigan. In total, the clinical immersion experience was 385 hours. OUTCOMES: Ninety one percent of patients experienced a transfer delay of one day or less, compared to 78% of patients in 2024. Process measure findings included case management involvement; (5/11, 45%), PCP listed in EMR; (3/11, 27%), and referral to outpatient diabetes program; (2/11, 18%). Outcome measure findings revealed no patients with a 30-day ED visit/hospital readmission, or 90-day mortality. IMPACT: There was a 13% increase in patients being transferred in one day or less following implementation of this evidence-based project. It quantitatively supports transfer and discharge delays from the ICU were reduced without adverse outcomes. All 19 CNL role competencies were achieved.
Direct Discharge Home from the Intensive Care Unit: A Modern Necessity?
Hager-Lubbers Exhibition Hall
PURPOSE: Decrease delay of transfer from the Intensive Care Unit (ICU) (in days) for patients with Diabetic Ketoacidosis (DKA) by implementing Direct Discharge Home (DDH) from the ICU. Facilitating safe transitions of care between healthcare settings and demonstrating stewardship of limited health care resources are key competencies for the Clinical Nurse Leader (CNL). CHALLENGE: Hospital overcrowding results in transfer delays from the ICU to lower levels of care. Delays may span several days, during which patients improve clinically and become discharge ready. This reality supports DDH from the ICU out of necessity. Evidence demonstrates this trend is not unique to this hospital but is an emerging trend in the healthcare industry overall.EXPERIENCE: This CNL immersion experience took place over two semesters in the ICU of a 240-bed acute care urban hospital in mid-Michigan. In total, the clinical immersion experience was 385 hours. OUTCOMES: Ninety one percent of patients experienced a transfer delay of one day or less, compared to 78% of patients in 2024. Process measure findings included case management involvement; (5/11, 45%), PCP listed in EMR; (3/11, 27%), and referral to outpatient diabetes program; (2/11, 18%). Outcome measure findings revealed no patients with a 30-day ED visit/hospital readmission, or 90-day mortality. IMPACT: There was a 13% increase in patients being transferred in one day or less following implementation of this evidence-based project. It quantitatively supports transfer and discharge delays from the ICU were reduced without adverse outcomes. All 19 CNL role competencies were achieved.