Does after-hours discharge of ICU patients influence outcome?

outcomes associated with untimely discharge of patients from the intensive care unit. These have included an increase in the risk of post-ICU mortality, 1-2,4-8 higher ICU readmission rates 4,6,7,9 and longer overall hospital length of stay 9 among patients discharged from the ICU after-hours. Ever since the publication of a seminal paper by Goldfrad and Rowan 1 nearly 10 years ago, an impression has prevailed that mortality following after-hours discharge of patients is due to premature discharge of existing ICU patients to make way for sicker ones. This explanation was questioned when similar results were reported from centres in which delayed discharges were more common than premature ones. 4,6 As a result, even after several years of investigation, it is unclear as to why after-hours discharge of patients from the ICU is associated with poor patient outcomes. It is also not clear whether the problem of untimely discharge of ICU patients is limited to large metropolitan hospitals of publicly funded health care systems (like Australia’s) or one that is more widespread. We therefore conducted a retrospective cohort study to explore the relationship between after-hours discharge from the ICU and subsequent mortality, as an initial part of an ongoing investigation designed to clarify the influence of premature or delayed discharge and not-for-resuscitation (NFR) status on mortality of patients discharged after-hours.