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Who gets the bed: Factors influencing the intensive care exit block - A qualitative study
Journal article   Open access   Peer reviewed

Who gets the bed: Factors influencing the intensive care exit block - A qualitative study

Frances Fengzhi Lin, Jacqueline Peet, Lauren Murray, Mahesh Ramanan, Kylie Jacobs, Jane Brailsford, Amelia Osmond, Moreblessing Kajevu, Peter Garrett, Alexis Tabah, …
International Journal of Nursing Studies, Vol.161, pp.1-9
2025
DOI: https://doi.org/10.1016/j.ijnurstu.2024.104949
PMID: 39536612
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1-s2.0-S0020748924002621-main712.43 kBDownloadView
Published Version Open Access CC BY V4.0

Abstract

After-hours discharge Barriers Discharge delay Facilitators Health professionals Intensive care unit Patient discharge
Background Patient flow problems, including discharge delay and after-hours discharge, have been a consistently major issue, especially for intensive care units (ICUs). Evidence suggests that discharge delay and after-hours discharge are associated with increased ICU and hospital length of stay, leading to worsened patient outcomes and increased healthcare costs. They can also increase ICU readmission and post-ICU mortality. The factors influencing discharge processes are not well elucidated. Objective This study aimed to explore the barriers and facilitators to the ICU patient discharge processes in adult ICUs. Methods This qualitative exploratory multisite observational study was conducted in three regional adult ICUs in Queensland, Australia. We used staff interviews, fieldnotes, and document analysis as data collection techniques. Data analysis commenced with a deductive content analysis using the Structure, Process, and Outcomes framework. Following this, an inductive process was taken using the Theoretical Domains Framework. Findings We conducted 59 staff interviews and analysed the discharge documents across three sites. Four domains, including context and resources, beliefs about consequences, social/professional role and identity, and behaviour regulation, were strongly related to the factors that influenced the discharge processes. The findings revealed barriers to discharge, including finding the right bed, disconnected and ineffective information systems, ineffective communication and coordination within and across teams and departments, and uncertainty and inconsistency in discharge decision making. Facilitators included clarity on professional roles in ICU discharge, effective communication within the ICU team, and context specific strategies to support the discharge processes. Conclusions The findings provide an in-depth understanding of the barriers and facilitators to the ICU discharge processes. Multifaceted strategies should be considered to facilitate and manage ICU discharge safely and efficiently, including the use of clearer discharge criteria and guidelines, digital systems that aid communication and coordination, and early planning of ICU patient discharge.

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Nursing

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