MARCH 2019 VOLUME 49 ISSUE 1 JOURNAL OF THE ROYAL COLLEGE OF PHYSICIANS OF EDINBURGH 23 J R Coll Physicians Edinb 2019; 49: 23–5 | doi: 10.4997/JRCPE.2019.104 ORIGINAL RESEARCH PAPER Clinical Abstract Introduction Acute medical trusts in the UK National Health Service are reporting bed occupancy rates in excess of 90%, secondary to severe resource constraints. 1 The reduction in patient flow has affected critical care capacity. The UK has one of the lowest numbers of critical care beds per population in Europe and is vulnerable to capacity issues. 2 The inability to step down patients from critical care in a timely manner has increased the number of patients discharged directly to the community from critical care. We report the trends in direct discharges from a District General Hospital with high susceptibility to capacity issues and evaluate the safety of this practice. Methods We conducted a retrospective, observational study of patients discharged directly into the community from the Critical Care Unit of Broomfield Hospital, a district general hospital with tertiary services, serving a population of more than 370,000 people in Essex. The study included all patients requiring Level 2 and 3 care. The study was performed as a local quality assessment review and did not require ethical approval. The study was approved by the institutional audit board. Data were extracted from an electronic database (Metavision version 5.46.44, iMDsoft, Germany), Intensive Care National Audit and Research Centre (ICNARC) audit data and from hospital records for all patients from January 2013 to the end of December 2018. Patients with planned readmission within 28 days and patients on end-of-life care were excluded from the study. All data were anonymised at point of collection. Two groups of patients were identified from the records; patients discharged to community from critical care (DH) and patients discharged into the community from a ward (DW). First, we analysed the trend from 2013 to 2018. In order to analyse safety of the DH, we also obtained the discharge and readmission data for all the patients in the hospital from January 2014 to the end of December 2016. When patients were admitted with multiple conditions, the primary reason for admission was considered the main diagnosis. A z test of proportion was used to compare the 28-day readmission rates and mortality between the two groups. Standard descriptive Background High bed occupancy rates have delayed patient discharges from UK critical care units, especially in acute medical hospitals. As a result, more patients are discharged home directly from critical care (DH). Methods In this observational, retrospective study, we quantify the trends in DH from 2013 to 2018, and assess readmission rates and outcome in this group when compared to patients discharged from a ward, from 2014 to 2016. Results DH rates, as a proportion of critical care admissions, increased every year (2.47% in 2013 to 19.36% in 2018). In 2014–16, the most common admission diagnoses in DH patients were diabetic ketoacidosis (DKA; 35%), drug overdose (12%), seizures (8%) and respiratory failure (8%). DH patients were younger and had shorter critical care stay. Readmission rates in DH patients were comparable to the rest of the hospital. Patients with DKA and seizures were more likely to be readmitted. Conclusions Our data suggest that direct home discharge from critical care is increasingly common but safe in selected patient groups. Keywords: direct discharge, safety, triage Financial and Competing Interests: No conflict of interests declared Correspondence to: Ashraf Roshdy 3 Cromwell Avenue Bromley BR2 9GB UK Email: ashrafroshdy76@hotmail. com 1 Core Medical Trainee, Watford General Hospital, West Hertfordshire Hospitals NHS Trust, Watford, UK; 2 Consultant in Critical Care Medicine, General ICU, St George’s University Hospitals NHS Trust, London, UK; 3 Consultant in Critical Care Medicine, Critical Care Department – Alexandria University, Egypt; 4–6 Consultant in Anaesthesia and Intensive Care Medicine, General ICU – Broomfield Hospital, Chelmsford, Mid Essex NHS Trust, UK Discharge home from critical care: safety assessment in a resource constrained system Siyao Xing 1 , Ashraf Roshdy 2,3 , Jayachandran Radhakrishnan 4 , Kevin Kiff 5 , Jake Collins 6