Li Pin, Boyd Jamie M, Ghali William A, Stelfox Henry T
Can Respir J. 2015 Mar-Apr;22(2):109-18. doi: 10.1155/2015/457431. Epub 2014 Dec 18.
To provide the first description of intensive care unit (ICU) discharge practices from the perspective of Canadian ICU administrators, and ICU providers from Canada, the United States and the United Kingdom.
The authors identified 140 Canadian ICUs and administered a survey to ICU administrators (unit manager, director) to obtain an institutional perspective. Also surveyed were members of professional critical care associations in Canada, the United States and the United Kingdom, using membership distribution lists, to obtain a provider perspective.
A total of 118 ICU administrators (114 ICUs [81%]) and 737 ICU providers (denominator unknown) responded to the survey. Administrator and provider respondents reported that ICU physicians are primarily responsible for determining the timing (70% and 77%, respectively) and safety (94% and 96%) for patients discharged from ICU. The majority of respondents indicated that patient summaries (87% and 85%) and medication reconciliation (78% and 79%) were part of their institutions' discharge process. One-half of respondents reported the use of discharge protocols, while a minority indicated that checklists (46% and 44%), electronic tools (19% and 28%) or outreach follow-up (44% and 33%) were used. The majority of respondents rated current ICU discharge practices to be of medium quality (57% and 58% scored 3 on a five-point scale). Suggested opportunities for improvement included the information provided to patients and families (71% and 59%) and collaboration among hospital units (65% and 66%).
Findings from the present study revealed the complexity of the ICU discharge process, considerable practice variation, perception of only medium quality and several proposed opportunities for improvement.
从加拿大重症监护病房（ICU）管理人员以及来自加拿大、美国和英国的ICU医护人员的角度，首次描述ICU的出院流程。
作者确定了140家加拿大ICU，并对ICU管理人员（科室经理、主任）进行了一项调查，以获取机构层面的观点。还通过会员分布名单对加拿大、美国和英国专业重症监护协会的成员进行了调查，以获取医护人员的观点。
共有118名ICU管理人员（114家ICU [81%]）和737名ICU医护人员（分母未知）回复了调查。管理人员和医护人员受访者表示，ICU医生主要负责确定从ICU出院患者的时间（分别为70%和77%）和安全性（94%和96%）。大多数受访者表示，患者总结（87%和85%）和用药核对（78%和79%）是其机构出院流程的一部分。一半的受访者报告使用了出院协议，而少数人表示使用了清单（46%和44%）、电子工具（19%和28%）或出院后随访（44%和33%）。大多数受访者将当前ICU的出院流程评为中等质量（57%和58%在五分制中得分为3分）。建议的改进机会包括向患者和家属提供的信息（71%和59%）以及医院各科室之间的协作（65%和66%）。
本研究的结果揭示了ICU出院流程的复杂性、相当大的实践差异、仅为中等质量的认知以及几个提议的改进机会。
