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Chest. 2015 Feb;147(2):317-327. doi: 10.1378/chest.13-2965.

A scoping review of patient discharge from intensive care: opportunities and tools to improve care.

Author information

1
Department of Critical Care Medicine, Department of Medicine, University of Calgary and Alberta Health Services - Calgary Zone, Calgary, AB; Department of Critical Care Medicine, University of Calgary and Alberta Health Services - Calgary Zone, Calgary, AB. Electronic address: tstelfox@ucalgary.ca.
2
Department of Critical Care Medicine, Department of Medicine, University of Calgary and Alberta Health Services - Calgary Zone, Calgary, AB.
3
Department of Critical Care Medicine, University of Calgary and Alberta Health Services - Calgary Zone, Calgary, AB.
4
Department of Community Health Sciences, Institute for Public Health, University of Calgary, Calgary, AB; Department of Community Health Sciences, Institute for Public Health, University of Calgary, Calgary, AB; Li Ka Shing Knowledge Institute, Saint Michael's Hospital, Toronto, ON; Department of Continuing Education and Professional Development, University of Toronto, Toronto, ON.
5
Department of Community Health Sciences, Institute for Public Health, University of Calgary, Calgary, AB; Li Ka Shing Knowledge Institute, Saint Michael's Hospital, Toronto, ON; Li Ka Shing Knowledge Institute, Saint Michael's Hospital, Toronto, ON; Department of Medicine Hospital, Saint Michael's University of Toronto, Toronto, ON.
6
Division of Critical Care, University of Alberta, Edmonton, AB; Department of Critical Care Medicine, Alberta Health Services - Edmonton Zone Edmonton, AB, Canada.

Abstract

BACKGROUND:

We conducted a scoping review to systematically review the literature reporting patient discharge from ICUs, identify facilitators and barriers to high-quality care, and describe tools developed to improve care.

METHODS:

We searched Medline, Embase, CINAHL, and the Cochrane Central Register of Controlled Trials. Data were extracted on the article type, study details for research articles, patient population, phase of care during discharge, and dimensions of health-care quality.

RESULTS:

From 8,154 unique publications we included 224 articles. Of these, 131 articles (58%) were original research, predominantly case series (23%) and cohort (16%) studies; 12% were narrative reviews; and 11% were guidelines/policies. Common themes included patient and family needs/experiences (29% of articles) and the importance of complete and accurate information (26%). Facilitators of high-quality care included provider-patient communication (30%), provider-provider communication (25%), and the use of guidelines/policies (29%). Patient and family anxiety (21%) and limited availability of ICU and ward resources (26%) were reported barriers to high-quality care. A total of 47 tools to facilitate patient discharge from the ICU were identified and focused on patient evaluation for discharge (29%), discharge planning and teaching (47%), and optimized discharge summaries (23%).

CONCLUSIONS:

Common themes, facilitators and barriers related to patient and family needs/experiences, communication, and the use of guidelines/policies to standardize patient discharge from ICU transcend the literature. Candidate tools to improve care are available; comparative evaluation is needed prior to broad implementation and could be tested through local quality-improvement programs.

Comment in

PMID:
25210942
DOI:
10.1378/chest.13-2965
[Indexed for MEDLINE]
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