Reengineering the Discharge of Elderly Patients from Intensive Care
The aim of this research was to better understand current intensive care unit (ICU) discharge practices.
Findings: Data from this study indicate that most providers, patients and family members perceive the transition of care from ICU to hospital ward to be effective. However, there are clear opportunities for improvement that can be used to guide interventions: (1) engage ward nurses in the transfer process, (2) develop a written communication tool to ensure transfer of all important clinical information between providers, (3) develop a written communication tool to inform patients and family members of the care received and ongoing treatment plan and (4) develop a goals of care reconciliation tool to ensure that goals of care are reviewed at the time of patient transfer.
Impact of findings: We anticipate that an ICU discharge tool kit will reduce errors by improving communication, reduce readmission by improving continuity of care plans, and reduce ICU/hospital length of stay by initiating earlier discharge planning. Administrators or policy makers could use the knowledge generated through this work to improve the allocation of scarce resources, reduce unnecessary healthcare costs and improve elderly patient satisfaction with care. Ultimately, improving the ICU discharge process is important for optimizing the quality of care provided to elderly patients during these high-risk transitions. Furthermore, our findings aim to enhance patient/family care experience by empowering patients/family to facilitate their own continuity of care.
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About the Project
The transition of patient care from the ICU to a hospital ward is a challenging time in healthcare delivery, often exposing patients to medical errors and adverse events. The critically ill frail elderly are at high risk of experiencing such an error or event.
The goal of this project was to describe the experiences and communication of stakeholders during patient transfer from ICU to hospital ward to identify opportunities to improve ICU discharge process and inform the development of an ICU discharge tool kit.
For more details on the project rationale, hypothesis, objectives and research plan, click here.
Henry Stelfox, BMSc, MD, PhD -- University of Calgary
Sean Bagshaw, MD, MSc, FRCPC -- University of Alberta
Peter Dodek, MD, MHSc -- University of British Columbia
Alan Forster, MD, FRCPC, MSc -- Ottawa Hospital Research Institute
Robert Fowler, MD, MSc -- Sunnybrook Research Institute
François Lamontagne, MD, MSc -- Université de Sherbrooke
Alexis Turgeon, MD, MSc -- Université Laval
Chaim Bell, PhD, MD -- University of Toronto
Niall Ferguson, MSc, MD -- University Health Network
William Ghali, MD, MPH, FRCPC -- University of Calgary
Daniel Niven, MD -- University of Calgary
Thomas Ricento, PhD -- University of Calgary
Orla Smith, PhD candidate, MN, BScN -- University of Toronto
Sharon Straus, MD, MSc, HBSc -- University of Toronto
Deborah White, PhD, MN, BScN, RN -- University of Calgary
Knowledge Users and Partners:
Paul Boucher -- Alberta Health Services
Chris Doig -- Alberta Health Services
Song Gao -- Alberta Health Services
Janice Lo -- University of British Columbia
Nancy Marlett -- Alberta Health Services
Claudio Martin -- Canadian Critical Care Society
Maire McAdams -- B.C. Ministry of Health
Tom Noseworthy -- University of Calgary
Dan Zuege -- Alberta Health Services
David Zygun -- Alberta Health Services
Project Contact: Dr. Henry Stelfox -- firstname.lastname@example.org
Key words: intensive care; critical care; elderly; quality of care; continuity of care; transitions of care; communication; chart review; surveys; interviews