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Cited by 69Hospital Admissions and OutcomesFamily and Patient Care in Intensive Care UnitsPatient Safety and Medication Errors

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

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Plotnikoff, Kara M., Krewulak, Karla D., Hernández, Laura, Spence, Krista, Foster, Nadine, Longmore, Shelly, Straus, Sharon E., Niven, Daniel J. +3 more·2021·Critical Care
DOI 10.1186/s13054-021-03857-2PMC PMC8684123
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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.

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Cited by

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Authors
Plotnikoff, K. M., Krewulak, K. D., Hernández, L., Spence, K., Foster, N., Longmore, S., Straus, S. E., Niven, D. J., Parsons Leigh, J., Stelfox, H. T., & Fiest, K. M.
Affiliations
  • Alberta Health Services (CA)
  • St. Michael's Hospital (CA)
Corresponding author
Fiest, Kirsten M.
ORCID
Venue
Critical Care
Publisher
Springer Science and Business Media LLC
Published
2021-12-17
Volume
25
Issue
1
Pages
438-438
ISSN
1364-8535 (ISSN-L)
DOI
10.1186/s13054-021-03857-2
PMC
PMC8684123
OpenAlex
W4200552282
Cited by
69
References
4
Citations by year
2026: 9 · 2025: 25 · 2024: 22 · 2023: 8 · 2022: 5
FWCI
2.41
Type
journal article
Language
en
Open access
Licence
Locations
  • Critical Care (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • TSpace (University of Toronto) (submittedVersion, other-oa)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Libraries and Cultural Resources (University of Calgary) (submittedVersion)
Funders
CIHR Transitions in Care (423947)
Topics
  • Health Sciences › Medicine › Emergency Medicine › Hospital Admissions and Outcomes
  • Health Sciences › Health Professions › Radiological and Ultrasound Technology › Family and Patient Care in Intensive Care Units
  • Health Sciences › Health Professions › Emergency Medical Services › Patient Safety and Medication Errors
Keywords
intensive care unit discharge, intensive care unit, patient transfer, discharge planning, discharge education, family involvement, provider-patient communication, hospital readmission, post-discharge mortality, adverse events, quality of care
MeSH terms
Adult, Child, Critical Care, Humans, Infant, Newborn, Intensive Care Units, Patient Discharge, Quality of Health Care, Critical Illness

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