Department of Critical Care Medicine, University of Calgary, 3260 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada.
Department of Community Health Sciences, University of Calgary, 3280 Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada.
BMC Health Serv Res. 2022 Jan 2;22(1):10. doi: 10.1186/s12913-021-07392-2.
Intensive care unit (ICU) patients undergoing transitions in care are at increased risk of adverse events and gaps in medical care. We evaluated existing patient- and family-centered transitions in care tools and identified facilitators, barriers, and implementation considerations for the application of a transitions in care bundle in critically ill adults (i.e., a collection of evidence-based patient- and family-centred tools to improve outcomes during and after transitions from the intensive care unit [ICU] to hospital ward or community).
We conducted a concurrent mixed methods (quan + QUAL) study, including stakeholders with experience in ICU transitions in care (i.e., patient/family partners, researchers, decision-makers, providers, and other knowledge-users). First, participants scored existing transitions in care tools using the modified Appraisal of Guidelines, Research and Evaluation (AGREE-II) framework. Transitions in care tools were discussed by stakeholders and either accepted, accepted with modifications, or rejected if consensus was achieved (≥70% agreement). We summarized quantitative results using frequencies and medians. Second, we conducted a qualitative analysis of participant discussions using grounded theory principles to elicit factors influencing AGREE-II scores, and to identify barriers, facilitators, and implementation considerations for the application of a transitions in care bundle.
Twenty-nine stakeholders attended. Of 18 transitions in care tools evaluated, seven (39%) tools were accepted with modifications, one (6%) tool was rejected, and consensus was not reached for ten (55%) tools. Qualitative analysis found that participants' AGREE-II rankings were influenced by: 1) language (e.g., inclusive, balance of jargon and lay language); 2) if the tool was comprehensive (i.e., could stand alone); 3) if the tool could be individualized for each patient; 4) impact to clinical workflow; and 5) how the tool was presented (e.g., brochure, video). Participants discussed implementation considerations for a patient- and family-centered transitions in care bundle: 1) delivery (e.g., tool format and timing); 2) continuity (e.g., follow-up after ICU discharge); and 3) continuous evaluation and improvement (e.g., frequency of tool use). Participants discussed existing facilitators (e.g., collaboration and co-design) and barriers (e.g., health system capacity) that would impact application of a transitions in care bundle.
Findings will inform future research to develop a transitions in care bundle for transitions from the ICU, co-designed with patients, families, providers, researchers, decision-makers, and knowledge-users.
在接受治疗的重症监护病房（ICU）患者在过渡期间面临更高的不良事件和医疗护理差距的风险。我们评估了现有的以患者和家庭为中心的过渡护理工具，并确定了在重症成人中应用过渡护理工具包的促进因素、障碍和实施考虑因素（即，一套基于证据的以患者和家庭为中心的工具，以改善从 ICU 到医院病房或社区的过渡期间和之后的结果）。
我们进行了一项同时进行的混合方法（quan + QUAL）研究，包括在 ICU 过渡护理方面有经验的利益相关者（即患者/家庭伙伴、研究人员、决策者、提供者和其他知识使用者）。首先，参与者使用经过修改的指南评估、研究和评估（AGREE-II）框架对现有的过渡护理工具进行评分。如果达成共识（≥70%的协议），则由利益相关者讨论过渡护理工具，要么接受，要么接受修改，要么拒绝。我们使用频率和中位数总结定量结果。其次，我们使用扎根理论原则对参与者的讨论进行定性分析，以引出影响 AGREE-II 评分的因素，并确定应用过渡护理工具包的障碍、促进因素和实施考虑因素。
有 29 位利益相关者参加了会议。在评估的 18 种过渡护理工具中，有 7 种（39%）工具经过修改后被接受，1 种（6%）工具被拒绝，10 种（55%）工具未达成共识。定性分析发现，参与者的 AGREE-II 排名受到以下因素的影响：1）语言（例如，包容性、行话和白话的平衡）；2）工具是否全面（即是否可以独立使用）；3）工具是否可以针对每个患者进行个性化；4）对临床工作流程的影响；5）工具的呈现方式（例如，小册子、视频）。参与者讨论了以患者和家庭为中心的过渡护理工具包的实施考虑因素：1）交付（例如，工具格式和时间）；2）连续性（例如，ICU 出院后的后续行动）；3）持续评估和改进（例如，工具使用的频率）。参与者讨论了应用过渡护理工具包的现有促进因素（例如，合作和共同设计）和障碍（例如，卫生系统能力）。
研究结果将为未来的研究提供信息，以与患者、家庭、提供者、研究人员、决策者和知识使用者共同设计从 ICU 过渡的过渡护理工具包。
