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

Abstract

Background Critically 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? Methods This 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. Results We 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. Conclusions Several 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.

A Delphi consensus study to identify priorities for improving and measuring medication safety for intensive care patients on transfer to a hospital ward

“…Some of our findings differed from the broader transitions in care medication safety recommendations or ICU practice. Patient engagement is acknowledged as a key factor in improving medication safety in transfers of care [ 7 ], and more generally, discharge education of patients and family members is an important facilitator to high-quality transfers from ICU [ 33 ]. In contrast, we found only the public panel agreed on the importance of medication information intervention components, while there was cross-panel agreement that patient and/or family satisfaction was an important medication outcome to measure.…”

Validation of manual to complement the transition of care at discharge from intensive care

“…The theme is relevant worldwide, especially in critical units, such as intensive care units (ICU), where adequate preparation and planning for discharge can minimize possible adverse events and other unfavorable clinical outcomes (1,3,4) . From this, the development of an interprofessional care manual of an educational nature, aimed at patients in intensive care and/or their caregivers, becomes a feasible and essential strategy, since through it, transitional care can occur in a more effective, accurate and qualified way (5,6) .…”

“…In order to improve the complex process that involves the discharge of critical patients, political-pedagogical strategies such as permanent health education, for the construction of the teaching-learning process and the development of critical and reflective thinking of the professional (4,9) , act as a way of qualifying transitional care (1,3) and can be developed verbally and/or using alternative methods, such as guidance manuals (10)(11)(12) . In this scenario, critical patients, in the process of discharge from the ICU and transferred to inpatient units are predisposed to a greater risk of adverse events, due to the severity of the disease, multiple comorbidities and complexity of care.…”

Validação de manual para complementar a transição de cuidados na alta da terapia intensiva

“…A relevância do tema é mundial, especialmente em unidades críticas, como as unidades de terapia intensiva (UTI), onde o preparo e o planejamento adequados de alta podem minimizar possíveis eventos adversos e outros desfechos clínicos desfavoráveis (1,3,4) . A partir disso, tem-se que o desenvolvimento de um manual de cuidado interprofissional de cunho educativo, voltado para pacientes em terapia intensiva e/ou seus cuidadores, torna-se uma estratégia factível e essencial, visto que por meio dele, o cuidado transicional pode ocorrer de forma mais efetiva, acurada e qualificada (5,6) .…”

“…A fim de melhorar o complexo processo que envolve a alta do paciente crítico estratégias político-pedagógicas como a educação permanente em saúde, para construção do processo de ensino-aprendizagem e do desenvolvimento de pensamento crítico e reflexivodo profissional (4,9) , servem como forma de qualificar o cuidado transicional (1,3) e podem ser desenvolvidas verbalmente e/ou utilizando métodos alternativos, como manuais de orientação (10)(11)(12) . Neste cenário, pacientes críticos, em processo de alta da UTI e transferidos para as unidades de internação estão predispostos a um risco maior de eventos adversos, devido à gravidade da doença, múltiplas comorbidades e complexidade do cuidado.…”