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Published VersionCC BY V4.0, Open Access
Journal article
Who gets the bed: Factors influencing the intensive care exit block - A qualitative study
International Journal of Nursing Studies, Vol.161, pp.1-9
2025
Abstract
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.
Details
- Title
- Who gets the bed: Factors influencing the intensive care exit block - A qualitative study
- Authors
- Frances Fengzhi Lin (Corresponding Author) - University of the Sunshine Coast, Queensland, School of Health - NursingJacqueline Peet - University of the Sunshine Coast, Queensland, School of Health - NursingLauren Murray - Sunshine Coast University HospitalMahesh Ramanan - Caboolture Hospital (Australia)Kylie Jacobs - Redcliffe HospitalJane Brailsford - Sunshine Coast University HospitalAmelia Osmond - Caboolture Hospital (Australia)Moreblessing Kajevu - Sunshine Coast University HospitalPeter Garrett - Sunshine Coast University HospitalAlexis Tabah - Redcliffe HospitalCarol Mock - Sunshine Coast University HospitalYingyan Chen - University of the Sunshine Coast, Queensland, School of Health - Nursing
- Publication details
- International Journal of Nursing Studies, Vol.161, pp.1-9
- Publisher
- Elsevier Ltd
- Date published
- 2025
- DOI
- 10.1016/j.ijnurstu.2024.104949
- ISSN
- 1873-491X; 0020-7489
- Grants
- Exploring the barriers and facilitators to patient discharge processes in regional intensive care units, and interventions to reduce discharge delays and after-hours discharge, 0980027766, University of the Sunshine Coast (Australia, Sunshine Coast) - UniSC
- Organisation Unit
- School of Health - Nursing
- Language
- English
- Record Identifier
- 991078296802621
- Output Type
- Journal article
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