Patient discharge from intensive care: an updated scoping review to identify tools and practices to inform high-quality care

Critical Care

Nadine Foster¹  Karla D. Krewulak¹  Shelly Longmore¹  Krista Spence¹  Laura Hernández¹  Kara M. Plotnikoff¹  Daniel J. Niven²  Henry T. Stelfox²  Kirsten M. Fiest³  Jeanna Parsons Leigh⁴  Sharon E. Straus⁵ 

[1] Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, 3134 Hospital Drive NW, T2N 4Z6, Calgary, AB, Canada;Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, 3134 Hospital Drive NW, T2N 4Z6, Calgary, AB, Canada;Department of Community Health Sciences and O’Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, 3134 Hospital Drive NW, T2N 4Z6, Calgary, AB, Canada;Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, 3134 Hospital Drive NW, T2N 4Z6, Calgary, AB, Canada;Department of Community Health Sciences and O’Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, 3134 Hospital Drive NW, T2N 4Z6, Calgary, AB, Canada;Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, 3134 Hospital Drive NW, T2N 4Z6, Calgary, AB, Canada;Department of Psychiatry, Cumming School of Medicine, University of Calgary and Alberta Health Services, 3134 Hospital Drive NW, T2N 4Z6, Calgary, AB, Canada;Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, 3134 Hospital Drive NW, T2N 4Z6, Calgary, AB, Canada;Faculty of Health, School of Health Administration, Dalhousie University, Sir Charles Tupper Medical Building, 2nd Floor, 5850 College Street, B3H 4R2, Halifax, NS, Canada;Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, East Building, M5B 1W8, Toronto, ON, Canada;Department of Geriatric Medicine, Faculty of Medicine, University of Toronto, 6 Queen’s Park Crescent West, Third Floor, M5S 3H2, Toronto, ON, Canada;

关键词: Critical care;    Intensive care;    Transitions in care;    Quality of care;    Patient discharge;   

DOI  :  10.1186/s13054-021-03857-2

来源: Springer

【 摘 要 】

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.

【 授权许可】

CC BY