Table 4 Facilitators and barriers to care during discharge from the ICU
Factor | Facilitator/ Barrier | All studies, n(%) (N = 314) |
|---|---|---|
Patient/family | ||
Facilitators | ||
Discharge education for patients and families | Facilitator | 82 (26.1) |
Family engagement/support system | Facilitator | 80 (25.5) |
Provider-patient communication | Facilitator | 77 (24.5) |
Patient demographic and clinical characteristics | Facilitator | 49 (15.6) |
Written communication for patients and families | Facilitator | 26 (8.3) |
Expectations of patients/family | Facilitator | 25 (8.0) |
Patient/family are treated as members of the healthcare team | Facilitator | 4 (1.3) |
Patient/family feelings of self-efficacy | Facilitator | 4 (1.3) |
Use of coping mechanisms | Facilitator | 3 (1.0) |
Excited, joyous to be leaving the ICU | Facilitator | 3 (1.0) |
Barriers | ||
Patient demographic and clinical characteristics | Barrier | 89 (28.3) |
Feelings of patient and family anxiety, embarrassment | Barrier | 70 (22.3) |
Expectations of patients/family | Barrier | 25 (8.0) |
Physical and psychological effects of illness (e.g., pain, nightmares) | Barrier | 23 (7.3) |
Lack of provider-patient communication | Barrier | 11 (3.5) |
ICU and hospital length of stay | Barrier | 9 (2.9) |
Financial obstacles (e.g., lack of insurance, cost of care) | Barrier | 5 (1.6) |
Socioeconomic factors of patient/family | Barrier | 5 (1.6) |
Logistical barriers to providing support (e.g., family lives far from hospital) | Barrier | 5 (1.6) |
Lack of familial support | Barrier | 2 (0.6) |
Feelings of lack of control | Barrier | 2 (0.6) |
Provider | ||
Facilitators | ||
Provider-provider communication | Facilitator | 77 (24.5) |
Critical care transition programs (e.g., outreach, liaison nurse) | Facilitator | 55 (17.5) |
Collaboration between ICU and ward | Facilitator | 44 (14.0) |
Written documentation for providers | Facilitator | 42 (13.4) |
Knowledge/experience of provider | Facilitator | 31 (9.9) |
Clinical judgment or decision-making | Facilitator | 30 (9.6) |
Clear roles/responsibility for providers | Facilitator | 17 (5.4) |
Multidisciplinary team | Facilitator | 8 (2.6) |
Provider leadership | Facilitator | 1 (0.3) |
Provider empathy to patient and family | Facilitator | 1 (0.3) |
Barriers | ||
Provider workload | Barrier | 21 (6.7) |
Lack of provider-provider communication | Barrier | 20 (6.4) |
Lack of knowledge/experience of provider | Barrier | 11 (3.5) |
Provider anxiety | Barrier | 6 (1.9) |
Organizational | ||
Facilitators | ||
Tools to facilitate discharge | Facilitator | 50 (15.9) |
Impact of current discharge practices on flow and performance | Facilitator | 36 (11.5) |
Guidelines or policies | Facilitator | 31 (9.9) |
Use of best practices | Facilitator | 30 (9.6) |
Discharge location from ICU | Facilitator | 30 (9.6) |
Education/training of providers | Facilitator | 29 (9.2) |
Time of discharge (day of week or time of day) | Facilitator | 15 (4.8) |
Availability of follow-up clinics or home support programs | Facilitator | 15 (4.8) |
Admission location before ICU | Facilitator | 7 (2.2) |
Hospital characteristics (e.g., trauma level) | Facilitator | 5 (1.6) |
Barriers | ||
Impact of current discharge practices on flow and performance | Barrier | 49 (15.6) |
Delay in discharge | Barrier | 32 (10.2) |
Time of discharge (day of week or time of day) | Barrier | 27 (8.6) |
Discharge location from ICU | Barrier | 25 (8.0) |
Limited ICU and ward resources | Barrier | 24 (7.6) |
Costs of healthcare provided | Barrier | 20 (6.4) |
Hospital characteristics (e.g., trauma level) | Barrier | 13 (4.1) |
Hospital or ICU capacity | Barrier | 10 (3.2) |
Admission location before ICU | Barrier | 5 (1.6) |
Physical and technological infrastructure (e.g., small patient rooms, no electronic health records) | Barrier | 5 (1.6) |
Lack of education/training of providers | Barrier | 4 (1.3) |
Staffing (e.g., change in nurse-to-patient ratios, not enough staff) | Barrier | 4 (1.3) |
Reduction in the levels of technology and monitoring when transition from ICU to ward | Barrier | 2 (0.6) |
Restricted visitation policies | Barrier | 1 (0.3) |