Guiding principles to optimise intensive care capacity

Abstract

Introduction: Exit block is a delay transferring patients who have been medically cleared for discharge from intensive care (IC). Exit block is associated with increased risks for patients, delays ICU admission for critically ill patients and wastes ICU capacity. An NSW multicentre study is under way that aims to implement strategies to reduce exit block and after hours discharge and evaluate the impact on patient outcomes and whole of hospital flow, including elective surgical and emergency treatment performance. Successful strategies will be implemented across NSW. In 2017, 40% of patients in NSW were exit blocked greater than 6h, equating to a loss of 33 available beds, costing an estimated $77.42 million AUD. Objectives/Aims: To identify key strategies participating sites can implement to reduce ICU exit block and optimise ICU/hospital capacity. Methods A diagnostic process included analyses ICU/ hospital data, staff surveys, patient/carer and staff interviews, process mapping of the ICU discharge process. Themes identified were paired with a review of available evidence and aligned with the NSW Ministry of Health patient flow systems framework. Intensive Care NSW, Agency for Clinical Innovation, developed a set of Guiding Principles to assist sites identify and implement appropriate improvement solutions. Results: Nine themes were identified. Four ICU-specific principles related to timely medical clearance, planning for, communicating and preparing patient for discharge. Five whole of hospital strategies focused on patient flow resources and processes, optimising ICU access, prioritisation for ICU discharges and effective utilization ICU, ward and speciality beds. Conclusion: ICU exit block is a significant problem affecting units across NSW with potential to negatively impact the care of critically ill patients. The Guiding Principles aim to improve patient flow and the experience for staff, patients and families. Sites should consider these guiding principles in designing strategies to reduce exit block and improve facility patient flow.