A nationwide survey of intensive care unit discharge practices

Heidegger, Claudia-Paula; Treggiari, Miriam M.; Romand, Jacques-André

doi:10.1007/s00134-005-2831-x

Cited by 51 publications

(41 citation statements)

References 32 publications

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“…Standardization of handoff practices is recognized by The Joint Commission as a practice standard to promote patient safety and facilitate the delivery of consistent high-quality patient care. 39 A multitude of studies [39][40][41] have demonstrated the effectiveness of implementing standardized verbal handoff practices to decrease omissions in patient care information. However, the development of electronic resources that are supportive and reflective of these communication and decision-making patterns is lagging behind practice.…”

Section: Implementation Of Transfer Documentmentioning

confidence: 99%

“…However, the development of electronic resources that are supportive and reflective of these communication and decision-making patterns is lagging behind practice. 34,35,41 Implementation of an electronic transfer tool that included descriptions of the patient's history, progress, and current status was useful for interdisciplinary care providers 29,39 and was an effective tool for medical-surgical nurses to reflect upon after the immediate transfer period. 32 Several studies explored the integration of an interdisciplinary standardized handoff tool 34,36,37,40 ; however, the majority evaluated this measure from the perspective of alterations and effects on patient care activities, not from the perspective of care delivery outcomes.…”

Section: Implementation Of Transfer Documentmentioning

confidence: 99%

“…61,63,64 Computerized charting systems and patient data management systems have also been identified as effective and innovative methods to streamline medication reconciliation practices during transitions of care within the acute care setting and facilitate improved institutional compliance. 39,63 Conclusions Based on the Evidence…”

Section: Medication Reconciliation Practicesmentioning

confidence: 99%

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Role of Transitional Care Measures in the Prevention of Readmission After Critical Illness

Peters

2017

Critical Care Nurse

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Transitioning from the critical care unit to the medical-surgical care area is vital to patients’ recovery and resolution of critical illness. Such transitions are necessary to optimize use of available hospital resources to meet patient care needs. One in 10 patients discharged from the intensive care unit are readmitted to the unit during their hospitalization. Critical care readmission is associated with significant increases in illness acuity, overall length of stay, and health care costs as well as a potential 4-fold increased risk of mortality. Patients with complex illness, multiple comorbid conditions, and a prolonged initial stay in the critical care unit are at an increased risk of being readmitted to the critical care unit and experiencing poor outcomes. Implementing nurse-driven measures that support continuity of care and consistent communication practices such as critical care outreach services, transitional communication tools, discharge planning, and transitional care units improves transitions of patients from the critical care environment and reduces readmission rates.

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Section: Implementation Of Transfer Documentmentioning

confidence: 99%

Section: Implementation Of Transfer Documentmentioning

confidence: 99%

Section: Medication Reconciliation Practicesmentioning

confidence: 99%

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Role of Transitional Care Measures in the Prevention of Readmission After Critical Illness

Peters

2017

Critical Care Nurse

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“…Las políticas de admisión y altas de UCI no sólo son importantes para la gestión de los recursos disponibles, sino que también son clave para el resultado de la asistencia a pacientes críticos. Las recomendaciones para la admisión y altas de pacientes que se incluyen en guías no tienen una evidencia consistente y deben adaptarse a la situación particular de cada UCI y hospital 3,4 . La decisión de dar de alta de UCI a un paciente en particular se basa generalmente en consideraciones clínicas sobre una evolución favorable del paciente, en que el tratamiento o la vigilancia especial ya no serán necesarios y en la creencia de que las necesidades de cuidados serán satisfechas en el lugar de destino.…”

Section: Introductionunclassified

Impacto de las altas no programadas en la mortalidad hospitalaria tras la estancia en una unidad de cuidados intensivos

et al. 2011

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ORIGINALImpacto de las altas no programadas en la mortalidad hospitalaria tras la estancia en una unidad de cuidados intensivos ResumenObjetivos: Comprobar la frecuencia de altas no programadas y su relación con la mortalidad hospitalaria tras la estancia en UCI. Diseño: Registro prospectivo de los ingresos de 6 años consecutivos. Análisis retrospectivo de la primera admisión de la cohorte de los supervivientes a UCI. Ámbito: UCI polivalente de 10 camas en hospital general de segundo nivel con 540 camas. Pacientes: 1.521 pacientes con más de 12 horas de estancia, dados de alta vivos y con desenlace hospitalario conocido.Intervenciones: Ninguna. Principales variables de interés: Se registró el tipo de alta de la unidad, normal o no programada, y se exploró su relación con la mortalidad hospitalaria post-UCI, las tasas de readmisión y la estancia hospitalaria post-UCI. Resultados: Hubo 165 altas no programadas (10,8%). La tasa de mortalidad fue del 11,6% (176 pacientes). Los factores relacionados con la mortalidad fueron la limitación del esfuerzo terapéutico (OR = 14,02 [4,6]), las readmisiones (OR = 3,46 [1,78]), las altas no programadas (OR = 2,16 [1,41]), la puntuación de fallos orgánicos al alta de UCI (OR = 1,16 [1,01-1,32]) y la edad (OR = 1,03 [1,01-1,05]). Las readmisiones y las estancias post-UCI no diferían significativamente entre las altas no programadas y las normales (el 7,3 frente al 8,2%; p = 0,68 y 16, 7 ± 16,7 frente a 18,7 ± 21,3 días, respectivamente; p = 0,162). Conclusiones: Las altas no programadas son frecuentes en nuestro medio y contribuyen significativamente a la mortalidad post-UCI, sin que parezcan afectar a otros resultados de la asistencia a pacientes críticos. Impact of the premature discharge on hospital mortality after a stay in an intensive care unit Abstract Objective: To determine the frequency and to evaluate the relationship between premature discharge and post-ICU hospital mortality. Design: A prospective registry was made for patients admitted during six consecutive years, performing a retrospective analysis of the data on the first admission of ICU survivors. Setting: A 10-bed general ICU in a 540-bed tertiary-care community hospital. Patients: 1,521 patients with an ICU stay longer than 12 hours, discharged alive to wards with known hospital outcome. Interventions: None. Main variables:We recorded the patient data, including types of ICU discharge, normal or premature, and studying their relationship with post-ICU hospital mortality. The types of ICU discharge were also evaluated versus ICU readmission rate and post-ICU length of stay. Results: There were 165 patients (10.8%) with premature discharge. Mortality rate was 11.6% (176 patients). The factors related with mortality were withdrawal and limitation of life-sustaining treatments (OR=14. 02 [4.6-42.6 Conclusions: Premature discharges appear to be common in our setting and have a significant impact on mortality. Types of ICU discharge do not seem to be related with other outcome variables in the hospital care of cr...

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“…While some studies have centred on clinical decision making or discharge planning, 3,4 the literature tends to focus on resource streamlining or solely on clinical factors. Only a few studies acknowledge and address the complexity of clinical and non-clinical factors that mediate the decision-making practices of individual practitioners.…”

Section: Introductionmentioning

confidence: 99%

Discharge from Outpatient Orthopaedic Physiotherapy: A Qualitative Descriptive Study of Physiotherapists' Practices

Pashley

Powers²,

McNamee³

et al. 2010

Physiotherapy Canada

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Purpose: To describe the clinical and contextual factors that influence physiotherapists' discharge decision-making processes in outpatient orthopaedic settings. Methods: The study used a descriptive qualitative design that included three key-informant interviews and two focus groups (n ¼ 7) of orthopaedic physiotherapists (total n ¼ 10) working in the Greater Toronto Area. Interviews and focus groups followed a semi-structured interview guide that included questions pertaining to participants' discharge decision-making processes, salient contextual factors, and challenges. Data were coded and analyzed for emerging categories and themes using constant comparison techniques and group analyses. Results: Participants indicated that a combination of factors and strategies were brought to bear on discharge decision making but that the process changed with clinical experience. Over time, further emphasis was attributed to the patient's role in his or her rehabilitation, and self-management goals were increasingly promoted. Experience affected how therapists conceptualized their roles in discharge decisions and how they negotiated goals with patients. Conclusions: Discharge decision making is a complex process that requires integrating numerous factors and negotiating with patients. Physiotherapists' decision-making practices evolve with experience and reveal the complexity of implementing models of ''client-centred care'' in practice. Further research is needed to explore these findings in other settings. RÉ SUMÉObjectif : Dé crire les facteurs cliniques et contextuels qui influencent le processus de dé cision d'un physiothé rapeute quand vient le temps de donner congé à un patient en consultation externe en milieu orthopé dique. Mé thode : L'é tude a eu recours à une structure descriptive qualitative qui a né cessité trois entrevues informatives principales et deux groupes de discussion (n ¼ 7) formé s de physiothé rapeutes en orthopé die (n total ¼ 10) qui travaillent dans la ré gion du Grand Toronto. Un guide d'entrevues semistructuré es comprenant des questions portant sur le processus de dé cision de donner congé à un patient, sur les facteurs contextuels pré dominants et sur les dé fis propres à de telles dé cisions fut suivi pour les entrevues et les groupes de discussion. Les donné es furent codé es puis analysé es pour que puissent ê tre dé gagé s les caté gories et les thè mes é mergents à l'aide de techniques de comparaison constantes et d'analyses groupé es. Ré sultats : Les participants furent valoir qu'une combinaison de facteurs et de straté gies é tait prise en compte dans la dé cision de donner congé , mais que le processus é voluait suivant l'expé rience clinique. Avec le temps, l'accent é tait davantage mis sur le rô le du patient dans sa ré adaptation, et les objectifs d'autogestion é taient de plus en plus favorisé s. Le nombre d'anné es d'expé rience influait sur la faç on dont les thé rapeutes percevaient leur rô le dans les dé cisions de donner congé et dans leur maniè re de né gocier ...

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A nationwide survey of intensive care unit discharge practices

Cited by 51 publications

References 32 publications

Role of Transitional Care Measures in the Prevention of Readmission After Critical Illness

Role of Transitional Care Measures in the Prevention of Readmission After Critical Illness

Impacto de las altas no programadas en la mortalidad hospitalaria tras la estancia en una unidad de cuidados intensivos

Discharge from Outpatient Orthopaedic Physiotherapy: A Qualitative Descriptive Study of Physiotherapists' Practices

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