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Canadian Respiratory Journal
Volume 22, Issue 2, Pages 109-118
http://dx.doi.org/10.1155/2015/457431
Original Article

Stakeholder Views Regarding Patient Discharge from Intensive Care: Suboptimal Quality and Opportunities for Improvement

Pin Li,1,2 Jamie M Boyd,3 William A Ghali,1,2,3 and Henry T Stelfox1,2,3,4

1Department of Medicine, University of Calgary and Alberta Health Services – Calgary Zone, Canada
2Institute for Public Health Calgary Zone, Calgary, Alberta, Canada
3Department of Community Health Sciences, University of Calgary Calgary Zone, Calgary, Alberta, Canada
4Department of Critical Care Medicine, University of Calgary and Alberta Health Services – Calgary Zone, Calgary, Alberta, Canada

Copyright © 2015 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

OBJECTIVE: To provide the first description of intensive care unit (ICU) discharge practices from the perspective of Canadian ICU administrators, and ICU providers from Canada, the United States and the United Kingdom.

METHODS: The authors identified 140 Canadian ICUs and administered a survey to ICU administrators (unit manager, director) to obtain an institutional perspective. Also surveyed were members of professional critical care associations in Canada, the United States and the United Kingdom, using membership distribution lists, to obtain a provider perspective.

RESULTS: A total of 118 ICU administrators (114 ICUs [81%]) and 737 ICU providers (denominator unknown) responded to the survey. Administrator and provider respondents reported that ICU physicians are primarily responsible for determining the timing (70% and 77%, respectively) and safety (94% and 96%) for patients discharged from ICU. The majority of respondents indicated that patient summaries (87% and 85%) and medication reconciliation (78% and 79%) were part of their institutions’ discharge process. One-half of respondents reported the use of discharge protocols, while a minority indicated that checklists (46% and 44%), electronic tools (19% and 28%) or outreach follow-up (44% and 33%) were used. The majority of respondents rated current ICU discharge practices to be of medium quality (57% and 58% scored 3 on a five-point scale). Suggested opportunities for improvement included the information provided to patients and families (71% and 59%) and collaboration among hospital units (65% and 66%).

CONCLUSION: Findings from the present study revealed the complexity of the ICU discharge process, considerable practice variation, perception of only medium quality and several proposed opportunities for improvement.