Redesigning the ICU nursing discharge process: a quality improvement study
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Introduction: The ICU discharge process is complex. Despite professional guidelines for managing ICU discharge processes, there are wide variations in practice. Objectives: To evaluate the impact of a redesigned ICU nursing discharge process on ICU discharge delay, hospital mortality and ICU readmission within 72 h. Methods: After ethics approval, a quality improvement study using a time series design and statistical process control analysis was conducted in one Australian general ICU. The primary outcome measure was hours of discharge delay per patient discharged alive per month, measured 15 months prior to and 12 months after the redesigned process was implemented. The redesign process included developing a patient handover sheet, requesting ward staff to nominate an estimated transfer time, a daily ICU discharge alert sheet and an expected date of discharge to be recorded in the ICU notes. Results: A total of 1787 ICU discharges were included in this study, 1001 in the 15 months before and 786 in the 12 months after the implementation of the new discharge processes. There was no difference in hospital mortality or ICU readmission within 72 h during the study period. However, process improvement was demonstrated by a reduction in the average patient discharge delay time of 3.2 h (from 4.6 h baseline to 1.0 h post-intervention). Conclusions: Involving both ward and ICU staff in the redesign process may have contributed to a shared situational awareness of the problems, which led to more timely and effective ICU discharge processes.
Australian Critical Care, vol 24(1)
Clinical Nursing: Secondary (Acute Care)