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.

Research Results

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.

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.

Project Team

Principal Investigators:

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

Co-Investigators:

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 — tstelfox@ucalgary.ca

CORE 2013-12

Key words: intensive care; critical care; elderly; quality of care; continuity of care; transitions of care; communication; chart review; surveys; interviews