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Critical Care
Published in: Critical Care 1/2021

Open Access 01-12-2021 | Care | Research

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

Authors: Kara M. Plotnikoff, Karla D. Krewulak, Laura Hernández, Krista Spence, Nadine Foster, Shelly Longmore, Sharon E. Straus, Daniel J. Niven, Jeanna Parsons Leigh, Henry T. Stelfox, Kirsten M. Fiest

Published in: Critical Care | Issue 1/2021

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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.
Appendix
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Metadata
Title
Patient discharge from intensive care: an updated scoping review to identify tools and practices to inform high-quality care
Authors
Kara M. Plotnikoff
Karla D. Krewulak
Laura Hernández
Krista Spence
Nadine Foster
Shelly Longmore
Sharon E. Straus
Daniel J. Niven
Jeanna Parsons Leigh
Henry T. Stelfox
Kirsten M. Fiest
Publication date
01-12-2021
Publisher
BioMed Central
Keyword
Care
Published in
Critical Care / Issue 1/2021
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-021-03857-2

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