Table 1 Summary of data abstraction for themes, and facilitators and barriers to a successful transition in care
Theme | Example |
|---|---|
ICU Discharge Themes | |
Adverse events, readmission, and mortality following discharge | ICU or emergency department readmission rates; Mortality following ICU discharge in a given time frame (e.g., one year after discharge) |
Patient and family needs and experiences during discharge | Patients or families desire for more information about the next steps in care; Appreciation for the attentiveness of nursing staff in ICU |
Planning for discharge | Notifying subsequent care providers about the patient’s condition; Aligns with planning for discharge in the phase of care model |
Continuity of patient care | Use of a transition program or follow-up clinics—patients understand where to seek care after ICU discharge |
Discharge education for patients and families | Programs that provide information on what is to be expected after discharge and when to seek medical help |
Standardizing the discharge process | Use of guidelines or protocols to ensure the discharge process is the same for all patients |
Availability of complete and accurate discharge information | Use of medical records, checklists, or summaries to provide appropriate information to either healthcare providers, family members, or patients |
Evaluating patient readiness for discharge | Use of clinical scoring assessments to determine severity of illness, marked progress in patient condition; Aligns with phase of care examined |
Anxiety associated with discharge | Patient or family feelings of anxiousness about transitioning to a different level of care or worrying about leaving the ICU |
Timeliness of discharge | Time of day discharge occurs (daytime versus nighttime), and if there is a delay in discharge (patient has been ready for discharge for several days but has not been transitioned out of ICU) |
Resource use during discharge | Use of supplies, infrastructure, or staff time to facilitate the discharge |
Critical care transition program | Presence of a dedicated team that works with ICU and the receiving care providers to improve the transition. May include a nurse liaison or outreach team |
Medication reconciliation | Verifying that medications started in the ICU should be continued after discharge |
Autonomy | Patients feeling like they have a say in their discharge and/or subsequent care |
Discharge education for providers | Programs that teach ward staff what to expect from an ICU patient; Education for ICU providers about facilitating a successful ICU discharge |
Facilitators for a successful ICU discharge | |
Patients and family | Discharge education for patients and families; Family engagement/support system; Provider-patient communication; Patient demographic and clinical characteristics; Written communication for patients and families; Expectations of patients/family; Patient/family are treated as members of the healthcare team; Patient/family feelings of self-efficacy; Use of coping mechanisms; Excited, joyous to be leaving the ICU |
Healthcare providers | Provider-provider communication; Critical care transition programs (e.g., outreach, liaison nurse); Collaboration between ICU and ward; Written documentation for providers; Knowledge/experience of provider; Clinical judgment or decision-making; Clear roles/responsibility for providers; Multidisciplinary team; Provider leadership; Provider empathy to patient and family |
Organization | Tools to facilitate discharge; Impact of current discharge practices on flow and performance; Guidelines or policies; Use of best practices; Discharge location from ICU; Education/training of providers; Time of discharge (day of week or time of day); Availability of follow-up clinics or home support programs; Admission location before ICU; Hospital characteristics (e.g., trauma level); |
Barriers to a successful ICU discharge | |
Patients and family | Patient demographic and clinical characteristics; Feelings of patient and family anxiety, embarrassment; Expectations of patients/family; Physical and psychological effects of illness (e.g., pain, nightmares; Lack of provider-patient communication; ICU and hospital length of stay; Financial obstacles (lack of insurance, cost of care); Socioeconomic factors of patient/ family; Logistical barriers to providing support (e.g., family lives far from hospital); Lack of familial support; Feelings of lack of control |
Healthcare providers | Provider workload; Lack of provider-provider communication; Lack of knowledge/experience of provider; Provider anxiety |
Organization | Impact of current discharge practices on flow and performance; Delay in discharge; Time of discharge (day of week or time of day); Limited ICU and ward resources; Costs of healthcare provided; Hospital characteristics (e.g., trauma level); Hospital or ICU capacity; Admission location before ICU; Physical and technological infrastructure (small patient rooms, no electronic health records; Lack of education/training of providers; Reduction in the levels of technology and monitoring when transition from ICU to ward; Restricted visitation policies |