Abstract
BackgroundTo use intensive care unit (ICU) facilities efficiently and ensure high quality of care, an optimal patient flow is necessary. Discharging patients relieves the pressure on ICU beds but the risk of premature discharge must be managed carefully. Suboptimal patient discharge may result in ICU readmissions and in patients’ death.The aim of this study is to obtain insight into the safety and efficiency of current ICU discharge practices and into barriers and facilitators to the implementation of effective ICU discharge interventions, and to develop an implementation strategy tailored to the barriers and facilitators identified.Methods/designThis study exists of five phases. Phase A: analysis of routinely registered data on variation in ICU readmissions and hospital mortality after ICU discharge of all ICUs participating in the Dutch National Intensive Care Evaluation registry (n = 83). Phase B: systematic review of effective interventions aiming to improve the efficiency and safety of the ICU discharge process. Phase C: assessing the intervention adherence with a questionnaire survey among all Dutch ICUs (n = 90). Phase D: assessing barriers and facilitators to the implementation of effective ICU discharge interventions with a questionnaire survey among all Dutch intensivists (n = 700). The questionnaire will be based on barriers and facilitators identified by focus groups (n = 4) and individual interviews with professionals of ICUs and general wards and adult discharged ICU patients (n = 25 to 30). Phase E: systematic development of an implementation strategy based on the sampled data in phase A to D, and effective implementation strategies from the literature using the intervention mapping method.DiscussionUsing theory and empirical data, an implementation strategy will be developed to improve the safety and efficiency of the ICU discharge process. The developed strategy will be evaluated in a subsequent study. The knowledge obtained in this study should be used for further implementation of ICU discharge interventions, and can be used for implementation of handover interventions in other healthcare transition settings.
Highlights
To use intensive care unit (ICU) facilities efficiently and ensure high quality of care, an optimal patient flow is necessary
The knowledge obtained in this study should be used for further implementation of ICU discharge interventions, and can be used for implementation of handover interventions in other healthcare transition settings
The inclusion criteria will be: studies with experimental study designs; that include patients undergoing and/or healthcare providers involved in the transition from ICU to ward; that have an intervention explicitly describing one or more components aiming to improve the handover from ICU to ward; and that have ICU readmission rate or hospital mortality rate after ICU admission as an outcome measure
Summary
The goal of this study is to obtain more insight into current ICU discharge practices, and into the barriers and facilitators to the implementation of effective ICU discharge interventions. Improvement may be found in better adherence to effective ICU discharge interventions. A complete and in-depth view of the ICU discharge process is ensured, which is necessary for developing a tailored implementation strategy. The NICE registry, a national database, contains data of almost every ICU patient in the Netherlands; 92% of all ICUs participate This results in a nearly complete overview of characteristics of the ICU population and quality of ICU care. Based on the results of this study, a tailor-made implementation strategy will be developed to improve the implementation of effective ICU discharge interventions in daily practice. All authors read and approved the final manuscript
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