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Published VersionCC BY V4.0, Open Access
Journal article
Interventions to improve patient admission and discharge practices in adult intensive care units: A systematic review
Intensive & Critical Care Nursing, Vol.85, pp.1-10
2024
PMID: 38494383
Abstract
Objectives
To identify and synthesise interventions and implementation strategies to optimise patient flow, addressing admission delays, discharge delays, and after-hours discharges in adult intensive care units.
Methods
This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines. Five electronic databases, including CINAHL, PubMed, Emcare, Scopus, and the Cochrane Library, were searched from 2007 to 2023 to identify articles describing interventions to enhance patient flow practices in adult intensive care units. The Critical Appraisal Skills Program (CASP) tool assessed the methodological quality of the included studies. All data was synthesised using a narrative approach.
Setting.
Adult intensive care units.
Results
Eight studies met the inclusion criteria, mainly comprising quality improvement projects (n = 3) or before-and-after studies (n = 4). Intervention types included changing workflow processes, introducing decision support tools, publishing quality indicator data, utilising outreach nursing services, and promoting multidisciplinary communication. Various implementation strategies were used, including one-on-one training, in-person knowledge transfer, digital communication, and digital data synthesis and display. Most studies (n = 6) reported a significant improvement in at least one intensive care process-related outcome, although fewer studies specifically reported improvements in admission delays (0/0), discharge delays (1/2), and after-hours discharge (2/4). Two out of six studies reported significant improvements in patient-related outcomes after implementing the intervention.
Conclusion
Organisational-level strategies, such as protocols and alert systems, were frequently employed to improve patient flow within ICUs, while healthcare professional-level strategies to enhance communication were less commonly used. While most studies improved ICU processes, only half succeeded in significantly reducing discharge delays and/or after-hours discharges, and only a third reported improved patient outcomes, highlighting the need for more effective interventions.
Implications for clinical practice
The findings of this review can guide the development of evidence-based, targeted, and tailored interventions aimed at improving patient and organisational outcomes.
Details
- Title
- Interventions to improve patient admission and discharge practices in adult intensive care units: A systematic review
- Authors
- Frances Fengzhi Lin (Corresponding Author) - University of the Sunshine Coast, Queensland, School of Health - NursingYingyan Chen - University of the Sunshine Coast, Queensland, School of Health - NursingMegan Rattray - Flinders UniversityLauren Murray - Sunshine Coast University HospitalKylie Jacobs - Redcliffe HospitalJane Brailsford - Sunshine Coast University HospitalPatricia Free - Caboolture Hospital (Australia)Peter Garrett - Sunshine Coast University HospitalAlexis Tabah - Redcliffe HospitalMahesh Ramanan - Caboolture Hospital (Australia)
- Publication details
- Intensive & Critical Care Nursing, Vol.85, pp.1-10
- Publisher
- Elsevier Ltd
- Date published
- 2024
- DOI
- 10.1016/j.iccn.2024.103688
- ISSN
- 1532-4036; 0964-3397
- PMID
- 38494383
- Copyright note
- © 2024 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
- Organisation Unit
- School of Health - Nursing
- Language
- English
- Record Identifier
- 991010298802621
- Output Type
- Journal article
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