A qualitative exploration of the discharge process and factors predisposing to readmissions to the intensive care unit

Uchenna R. Ofoma, Yue Dong, Ognjen Gajic, Brian W Pickering

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

BACKGROUND: Quantitative studies have demonstrated several factors predictive of readmissions to intensive care. Clinical decision tools, derived from these factors have failed to reduce readmission rates. The purpose of this study was to qualitatively explore the experiences and perceptions of physicians and nurses to gain more insight into intensive care readmissions.

METHODS: Semi-structured interviews of intensive care unit (ICU) and general medicine care providers explored work routines, understanding and perceptions of the discharge process, and readmissions to intensive care. Participants included ten providers from the ICU setting, including nurses (n = 5), consultant intensivists (n = 2), critical care fellows (n = 3) and 9 providers from the general medical setting, nurses (n = 4), consulting physicians (n = 2) and senior resident physicians (n = 3). Principles of grounded theory were used to analyze the interview transcripts.

RESULTS: Nine factors within four broad themes were identified: (1) patient factors - severity-of-illness and undefined goals of care; (2) process factors - communication, transitions of care; (3) provider factors - discharge decision-making, provider experience and comfort level; (4) organizational factors - resource constraints, institutional policies.

CONCLUSIONS: Severe illness predisposes ICU patients to readmission, especially when goals of care were not adequately addressed. Communication, premature discharge, and other factors, mostly unrelated to the patient were also perceived by physicians and nurses to be associated with readmissions to intensive care. Quality improvement efforts that focus on modifying or improving aspects of non-patient factors may improve outcomes for patients at risk of ICU readmission.

Original languageEnglish (US)
Number of pages1
JournalBMC Health Services Research
Volume18
Issue number1
DOIs
StatePublished - Jan 5 2018

Fingerprint

Critical Care
Causality
Intensive Care Units
Nurses
Patient Care Planning
Physicians
Communication
Organizational Policy
Interviews
Patient Transfer
Patient Readmission
Consultants
Quality Improvement
Decision Making
Medicine

Keywords

  • Discharge
  • Intensive care
  • Patient safety
  • Readmission
  • Transitions of care

ASJC Scopus subject areas

  • Health Policy

Cite this

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title = "A qualitative exploration of the discharge process and factors predisposing to readmissions to the intensive care unit",
abstract = "BACKGROUND: Quantitative studies have demonstrated several factors predictive of readmissions to intensive care. Clinical decision tools, derived from these factors have failed to reduce readmission rates. The purpose of this study was to qualitatively explore the experiences and perceptions of physicians and nurses to gain more insight into intensive care readmissions.METHODS: Semi-structured interviews of intensive care unit (ICU) and general medicine care providers explored work routines, understanding and perceptions of the discharge process, and readmissions to intensive care. Participants included ten providers from the ICU setting, including nurses (n = 5), consultant intensivists (n = 2), critical care fellows (n = 3) and 9 providers from the general medical setting, nurses (n = 4), consulting physicians (n = 2) and senior resident physicians (n = 3). Principles of grounded theory were used to analyze the interview transcripts.RESULTS: Nine factors within four broad themes were identified: (1) patient factors - severity-of-illness and undefined goals of care; (2) process factors - communication, transitions of care; (3) provider factors - discharge decision-making, provider experience and comfort level; (4) organizational factors - resource constraints, institutional policies.CONCLUSIONS: Severe illness predisposes ICU patients to readmission, especially when goals of care were not adequately addressed. Communication, premature discharge, and other factors, mostly unrelated to the patient were also perceived by physicians and nurses to be associated with readmissions to intensive care. Quality improvement efforts that focus on modifying or improving aspects of non-patient factors may improve outcomes for patients at risk of ICU readmission.",
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T1 - A qualitative exploration of the discharge process and factors predisposing to readmissions to the intensive care unit

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AU - Dong, Yue

AU - Gajic, Ognjen

AU - Pickering, Brian W

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N2 - BACKGROUND: Quantitative studies have demonstrated several factors predictive of readmissions to intensive care. Clinical decision tools, derived from these factors have failed to reduce readmission rates. The purpose of this study was to qualitatively explore the experiences and perceptions of physicians and nurses to gain more insight into intensive care readmissions.METHODS: Semi-structured interviews of intensive care unit (ICU) and general medicine care providers explored work routines, understanding and perceptions of the discharge process, and readmissions to intensive care. Participants included ten providers from the ICU setting, including nurses (n = 5), consultant intensivists (n = 2), critical care fellows (n = 3) and 9 providers from the general medical setting, nurses (n = 4), consulting physicians (n = 2) and senior resident physicians (n = 3). Principles of grounded theory were used to analyze the interview transcripts.RESULTS: Nine factors within four broad themes were identified: (1) patient factors - severity-of-illness and undefined goals of care; (2) process factors - communication, transitions of care; (3) provider factors - discharge decision-making, provider experience and comfort level; (4) organizational factors - resource constraints, institutional policies.CONCLUSIONS: Severe illness predisposes ICU patients to readmission, especially when goals of care were not adequately addressed. Communication, premature discharge, and other factors, mostly unrelated to the patient were also perceived by physicians and nurses to be associated with readmissions to intensive care. Quality improvement efforts that focus on modifying or improving aspects of non-patient factors may improve outcomes for patients at risk of ICU readmission.

AB - BACKGROUND: Quantitative studies have demonstrated several factors predictive of readmissions to intensive care. Clinical decision tools, derived from these factors have failed to reduce readmission rates. The purpose of this study was to qualitatively explore the experiences and perceptions of physicians and nurses to gain more insight into intensive care readmissions.METHODS: Semi-structured interviews of intensive care unit (ICU) and general medicine care providers explored work routines, understanding and perceptions of the discharge process, and readmissions to intensive care. Participants included ten providers from the ICU setting, including nurses (n = 5), consultant intensivists (n = 2), critical care fellows (n = 3) and 9 providers from the general medical setting, nurses (n = 4), consulting physicians (n = 2) and senior resident physicians (n = 3). Principles of grounded theory were used to analyze the interview transcripts.RESULTS: Nine factors within four broad themes were identified: (1) patient factors - severity-of-illness and undefined goals of care; (2) process factors - communication, transitions of care; (3) provider factors - discharge decision-making, provider experience and comfort level; (4) organizational factors - resource constraints, institutional policies.CONCLUSIONS: Severe illness predisposes ICU patients to readmission, especially when goals of care were not adequately addressed. Communication, premature discharge, and other factors, mostly unrelated to the patient were also perceived by physicians and nurses to be associated with readmissions to intensive care. Quality improvement efforts that focus on modifying or improving aspects of non-patient factors may improve outcomes for patients at risk of ICU readmission.

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KW - Transitions of care

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