"She was fine when she left us..." Improving patient care post ICU discharge

"SHE WAS FINE WHEN SHE LEFT US..."IMPROVING PATIENT CARE POST ICU DISCHARGE

Dr Richard Morrison CT1 UHD

Dr Keith Oakes ST3 MIH

Antrim Area Hospital ICU 2013/2014

BACKGROUND

Discharge from ICU represents a huge reduction in the

intensity of clinical care and intervention

Communication between sending and receiving teams is

generally poor (Ghali 2011)

This, in turn, can have a massive impact on patient safety

and satisfaction (Arora 2005)

GUIDELINES

Good Medical Practice GMC 2013

CCaNNI Discharge Guidelines

Core Standards for Intensive Care Units- FICM/ICS 2013

Royal College of Physicians- Consistent Structure for

Handover Record and Communication

GUIDELINES

GMC Good Medical Practice 2013:

Communication, Partnership and

Teamwork

GUIDELINES

'Core Standards for ICUs':

the Faculty of Intensive

Care Medicine; Intensive

Care Society 2013

INSTITUTE OF MEDICINE

Six aims for a

21st century

healthcare

system (2000)

Stelfox et al 2013

THE PROBLEM

December 2013

Review of 20 charts of patients discharged from the ICU

Outcome measures:

Documented verbal handover to receiving team

Review within 6 hours of arriving on the ward

Consultant review within 48 hours of arriving on the ward

CCaNNI discharge letter completed

Patient discharge letter completed

RESULTS DECEMBER 2013

Documented verbal handover: 10%

CCaNNI discharge letter completed: 95%

Patient discharge letter: 20%

Review within 6 hours: 5%

Consultant review within 48 hours: 90%

THE PLAYERS

The Sending Team

The Receiving Team

The Patient

THE SOLUTION?

ICU discharge pro-forma

Identify ICU discharges at

H@N meeting

THE EFFECT

July 2014

Review of 19 charts of discharged patients

RESULTS JULY 2014

Documented verbal handover: 79% (10%)

CCaNNI discharge letter: 100% (95%)

Patient discharge letter: 24% (20%)

Review within 6 hours: 74% (5%)

Consultant review within 48 hours: 89% (90%)

THE ONGOING ISSUE

While verbal medic to medic handover and prompt review of

newly discharged patients has improved, information given

to patients remains poor

Increasing the involvement of patients and relatives in the

discharge process can reduce anxiety (Courtney 2004)

Patient Discharge Letter provides access to the ICU follow

up clinic

THE FUTURE

Ongoing use of our discharge checklist

Ongoing audit of the effect and use of the checklist

Addition of our Patient Discharge Form to ECR

Ideally, the introduction of an Outreach Team...

REFERENCES

Ghali W, Li P, Stelfox HW. (2011) 'A Prospective Observational Study of

Physician Handoff for Intensive-Care-Unit-to-Ward Patient Transfers'

AMJMed http://dx.doi.org/10.1016/j.amjmed.2011.04.027

Arora V, Johnson J, Lovinger D, Humphrey HJ, Meltzer DO. (2005)

'Communication Failures in Patient Sign-Out and Suggestions for

Improvement: a Critical Incident Analysis' Qual Saf Health Care

2005;14:401-407 doi:10.1136/qshc.2005.015107

Stelfox HT et al. (2013) 'Identifying intensive care unit planning tools:

protocol for a scoping review' BMJ Open 2013;3:e002653

doi:10.1136/bmjopen-2013-002653

Courtney M, Mitchell M. (2004) Intensive and Critical Care Nursing vol20,

issue 4. 223-231.