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The influence of individual power and interdepartmental mistrust on the ICU patient discharge process
Abstract   Peer reviewed

The influence of individual power and interdepartmental mistrust on the ICU patient discharge process

Frances Lin, W Chaboyer and Marianne Wallis
Australian Critical Care, Vol.23(1), p.42
ANZICS/ACCCN Intensive Care Annual Scientific Meetings, 2009 (Perth, Australia, 29-Oct-2009–31-Oct-2009)
2010
DOI: https://doi.org/10.1016/j.aucc.2009.12.028
url
https://doi.org/10.1016/j.aucc.2009.12.028View
Published Version

Abstract

Nursing
Literature shows that organizational, individual and teamwork factors contribute to ICU patient discharge. However, there is limited research on how health professionals' position, power and trust influence ICU patient discharge process. This cognitive ethnographic study aimed to explore the ICU patient discharge process in an Australian Metropolitan tertiary teaching hospital. A total of 28 discharge processes were observed and 56 semi-structured interviews were undertaken, along with the collection of written policies and other documents to track the information flows and discharge decision-making process. Data triangulation techniques were used to enhance the rigor of the findings. The study was approved by two ethics committees and all participants signed consent forms. The influencing power of individual's position and interdepartmental mistrust on ICU discharge process was one major theme to emerge from the analysis. The research data showed that the influences of individuals had on discharge process were related to the responsibilities, accountabilities, and the ''power'' associated with the position they held in the organisation. Final discharge decisions were made and influenced by individuals who were in higher positions, and who had access and control of clinical resources. Senior medical staff's discharge decision-making processes were rarely challenged by junior medical staff. Interdepartmental mistrust impeded discharge process. The results suggested that clarification of ICU discharge criteria and minimum dataset for medical morning handover are needed to ensure patient safety and promote efficient use of clinical resources. Management of patients post ICU discharge needs to be further explored to build trust among the hospital departments.

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