Abstract
BackgroundCritically ill patients require complex care and experience unique needs during and after their stay in the intensive care unit (ICU). Discharging or transferring a patient from the ICU to a hospital ward or back to community care (under the care of a general practitioner) includes several elements that may shape patient outcomes and overall experiences. The aim of this study was to answer the question: what elements facilitate a successful, high-quality discharge from the ICU?MethodsThis scoping review is an update to a review published in 2015. We searched MEDLINE, EMBASE, CINAHL, and Cochrane databases from 2013-December 3, 2020 including adult, pediatric, and neonatal populations without language restrictions. Data were abstracted using different phases of care framework models, themes, facilitators, and barriers to the ICU discharge process.ResultsWe included 314 articles from 11,461 unique citations. Two-hundred and fifty-eight (82.2%) articles were primary research articles, mostly cohort (118/314, 37.6%) or qualitative (51/314, 16.2%) studies. Common discharge themes across all articles included adverse events, readmission, and mortality after discharge (116/314, 36.9%) and patient and family needs and experiences during discharge (112/314, 35.7%). Common discharge facilitators were discharge education for patients and families (82, 26.1%), successful provider-provider communication (77/314, 24.5%), and organizational tools to facilitate discharge (50/314, 15.9%). Barriers to a successful discharge included patient demographic and clinical characteristics (89/314, 22.3%), healthcare provider workload (21/314, 6.7%), and the impact of current discharge practices on flow and performance (49/314, 15.6%). We identified 47 discharge tools that could be used or adapted to facilitate an ICU discharge.ConclusionsSeveral factors contribute to a successful ICU discharge, with facilitators and barriers present at the patient and family, health care provider, and organizational level. Successful provider-patient and provider-provider communication, and educating and engaging patients and families about the discharge process were important factors in a successful ICU discharge.
Highlights
Ill patients require complex care and experience unique needs during and after their stay in the intensive care unit (ICU)
Transitions in care occur when a patient is being moved between healthcare settings or providers [1]
Transitions in care of critically ill patients from the ICU are even more complex because they include a change of care setting and often include a change in health status[11] characterized by severe illness [12], exacerbation of chronic medical problems [13], and newly acquired physical[12] and psychiatric[12] injuries
Summary
Ill patients require complex care and experience unique needs during and after their stay in the intensive care unit (ICU). Discharging or transferring a patient from the ICU to a hospital ward or back to community care (under the care of a general practitioner) includes several elements that may shape patient outcomes and overall experiences. Transitions in care occur when a patient is being moved between healthcare settings (e.g., intensive care unit [ICU] to hospital ward) or providers (e.g., changes in nursing shift) [1]. Transitions in care are complex, Plotnikoff et al Critical Care (2021) 25:438 requiring communication and coordination of care between multiple healthcare providers [1]. Differences between ICU and ward care may make transitions in care challenging; this includes patients transitioning from a unit with specialized technology and monitoring and lower nurse to patient ratios (ICU) to a less acute environment with higher nurse to patient ratios (ward) [18,19,20]
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