"she was fine when she left us..." improving patient care post icu discharge
TRANSCRIPT
"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
'Core Standards for ICUs':
the Faculty of Intensive
Care Medicine; Intensive
Care Society 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%
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.