The impact of critical care transition programs on outcomes after intensive care unit (ICU) discharge: can we get there from here?

Rosa, Régis Goulart; Maccari, Juçara Gasparetto; Cremonese, Ricardo Viegas; Tonietto, Túlio Frederico; Cremonese, Rafael Viégas; Teixeira, Cassiano

doi:10.21037/jtd.2016.05.30

Cited by 10 publications

(10 citation statements)

References 22 publications

(20 reference statements)

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“…The patient transition from the intensive care unit (ICU) to the general wards of a hospital is a complex process with many potential challenges [ 1 ]. It is also one of the most vulnerable transitions patients face [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

“…Poor management of the transition process has negative effects on the patient’s transition, health, treatment goals, and outcomes, and increases problems such as prolonged hospital stay, high cost of care, greater degree of disability, and psychological stress for the patient and family, and ultimately unavoidable death. In contrast, there is new evidence that organized care in the transition process has shown beneficial results for patients and their families that include greater satisfaction with care, successful transition, better preparation of the patient for transition and fewer visits to emergency clinics, as well as less need for re-hospitalization of these patients [ 1 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

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Challenges of the patient transition process from the intensive care unit: a qualitative study

et al. 2021

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Background:The transition of patients from the intensive care unit (ICU) to the general ward is challenging. Patients and caregivers experience high levels of anxiety during the transition period.This study aimed to explain the challenges that patients face during the transition process. Methods:In this qualitative research of conventional content analysis, data collection was conducted between February 2018 and July 2019 in educational hospitals affiliated with the Iran University of Medical Sciences. After obtaining informed consent, purposive sampling was performed with 22 nurses, intensive care physicians, anesthesiologists, and patients and their families using in-depth semi-structured interviews until data saturation. Results:The data obtained from the interviews indicated their perceptions and experiences, which are expressed scientifically through qualitative research. A total of 504 initial codes were extracted from continuous data analysis. The content analysis yielded three main themes in the challenges patients face during the transition process from the ICU: mixed feelings regarding transition (happiness/hope, worry/uncertainty, abandonment); care break (different atmosphere, the difference between the program and the quality of care, assigning care to the patient and family, and care culture and beliefs); and search for support and information (ineffective communication, self-care capacity of patient and family, ineffective and disrupted training, and weak follow-up programs), which inflicts care shock in the patients. Conclusions:The results showed that patients and their families were in a state of care shock during the ICU transition process and were sometimes disconcerted. It is necessary to design and implement care models according to the needs and challenges patients face during the transition period from ICU (patient-centered), based on the evidence available, and after considering the field of medicine and the accessibility of care in the country. The transition process can be improved and enhanced by obtaining knowledge about ICU transition care and related challenges as well as organizing a learning environment.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Challenges of the patient transition process from the intensive care unit: a qualitative study

et al. 2021

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“…CCSDPs arose from this and have become routinely embedded as an element of care. Although numerous researchers have called for RCTs, 4,13,57 these are impractical in this context because of the rapid and widespread adoption of Outreach in the United Kingdom and internationally and ethical concerns associated with allocating patients as controls. Alternatively robust quasi‐experimental designs, able to overcome the disadvantages of UBA studies are more suitable.…”

Section: Implications and Recommendationsmentioning

confidence: 99%

Routine critical care step‐down programmes: Systematic review and meta‐analysis

Tanner

Cornish

2020

Nursing in Critical Care

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Background Patients discharged from critical care to general hospital wards are vulnerable to clinical deterioration, critical care readmission, and death. In response, routine critical care stepdown programmes (CCSDPs) have been widely developed, which involve the review of all patients on general wards following discharge from critical care by multidisciplinary Outreach teams with critical care skills. Aims and objectives This review aims to answer the question: do routine CCSDPs reduce readmission and/or mortality among patients discharged from critical care? Design Systematic review of quantitative studies and meta‐analysis. Methods Six databases were comprehensively searched from inception (CENTRAL, Cochrane Reviews, MEDLINE, Embase, CINAHL and web of Science), alongside grey literature and trial registers. Studies investigating the effect of routine CCSDPs delivered by Outreach nurses on readmission and/or mortality following discharge from adult critical care to general hospital wards were included. Study quality was assessed using the Cochrane ROBINS‐I tool. Results Eight studies met the inclusion criteria, with data from 6 studies pooled in 3 meta‐analyses. Among patients exposed to routine CCSDPs, pooled data estimated a statistically nonsignificant reduction in the risk of readmission to critical care (risk ratio [RR] 0.85; 95% confidence interval [CI] 0.66‐1.09; P = .19), a statistically significant increase in the risk of readmission to critical care within 72 hours (RR 1.49; 95% CI 1.05‐2.12; P = .03), a statistically non‐significant reduction in risk of mortality following critical care discharge (RR 0.90; 95% CI 0.75‐1.07; P = .22), and no association with mortality within 14 days of discharge. Conclusion This review is unable to definitively conclude whether routine CCSDPs reduce critical care readmission or mortality following critical care discharge. Relevance to clinical practice While the synthesized evidence does not suggest a change in policy and practice are warranted, neither does it support routine CCSDPs in the absence of high‐quality evidence.

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“… 2 3 4 5 Additionally, transitions can result in increased stress for patients and families, who report being frequently inadequately prepared for a transition or excluded from the discussion and decision-making process. 6 , 7 One of the most frequent and difficult patient-care transitions occurs between critical care units and less acute settings, 8 , 9 particularly in the neonatal intensive care unit (NICU), where several transitions can occur within and between hospitals during a neonate’s hospital stay. 10 However, we know little about optimizing the transfer process of infants in the NICU.…”

Section: Introductionmentioning

confidence: 99%

A Quality Improvement Project to Decrease Suboptimal Patient Transfers between Two Neonatal Units

Douglas

Eriobu²,

Sanderson³

et al. 2023

Pediatric Quality &Amp; Safety

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Introduction. Poorly executed transitions of care in health care systems are associated with safety concerns and patient dissatisfaction. We noticed several problems in the transfer process between our neonatal intensive care unit (NICU) and special care nursery (SCN) and designed this quality improvement project to address them. The aim was to decrease suboptimal transfers from the NICU to the SCN by 50% over 9 months. We defined suboptimal transfers as the discharge of a patient within 3 days of transfer from the NICU to the SCN or the return of a patient to the NICU within 5 days of the transfer. Methods. We formed a multidisciplinary team and collected baseline data from October 2019 to December 2020. Major interventions included implementing a transfer checklist and algorithm. We utilized 3 staff surveys to evaluate the progress of the project. We used statistical process control charts to track project measures over time. Results. Patient demographics and SCN length of stay were similar for the baseline and postintervention periods. We decreased suboptimal transfers over 21 months (January 2021 to September 2022), achieved a significantly increased rate of parent notification before transfers (81% baseline versus 93% postintervention), and increased staff satisfaction with the transfer process (15% baseline versus 43% postintervention). Conclusions. We successfully improved the transfer process from our NICU to the SCN via a quality improvement project. Increased staff satisfaction and the lack of perception of additional burden to the staff from the new process are expected to sustain our results.

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The impact of critical care transition programs on outcomes after intensive care unit (ICU) discharge: can we get there from here?

Cited by 10 publications

References 22 publications

Challenges of the patient transition process from the intensive care unit: a qualitative study

Challenges of the patient transition process from the intensive care unit: a qualitative study

Routine critical care step‐down programmes: Systematic review and meta‐analysis

A Quality Improvement Project to Decrease Suboptimal Patient Transfers between Two Neonatal Units

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