Implementation and feasibility evaluation of a standard set of intensive care unit discharge criteria in a prospective before-after observational pilot study.
Maike Hiller, Antonia Brugger, Svea Nies, Alina Schenk, Maria Wittmann, Jan-Karl Schütte, Stefan Schröder, Reimer Riessen, Hendrik Bracht, Jan Bakker
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Abstract
Background: Identifying ICU patients stable enough for discharge to lower care levels is usually subjective. We previously derived a standardized discharge criteria set including patient-specific aspects and organizational capabilities. This study evaluated its implementation feasibility, clinical utility for objective discharge readiness assessment, and descriptive patient flow and safety related outcome parameters in routine care.
Methods: A prospective two-phase before-after observational pilot study was conducted in two German ICUs in 2022. During baseline, discharge-readiness workflows were observed. After criteria-set implementation and pre-testing, criteria completion, user feedback, patient-flow, acuity, and capacity parameters were collected. Due to small cohorts, only descriptive statistics were reported.
Results: Eleven mainly patient-specific and some organization-specific criteria reached > 80% completion at discharge decision and were defined as a core set. User feedback supported extending this core set with organization-related criteria according to clinical setting, patient groups, pathways, and receiving-unit capabilities. Discharge readiness assessment should involve all relevant stakeholders to align care needs with available capabilities.
Conclusions: A core set of eleven criteria indicated ICU discharge readiness in clinical routine. Organization-specific criteria can support adaptation to different patient subgroups and pathways. Workflow integration may support timely and safe transfers, but patient flow and safety effects require validation in larger studies. Holistic discharge readiness assessment requires coordinated pathway-management processes along the care continuum. Future implementation should prioritize reporting automation, intuitive visualization, and workflow-integrated documentation, ideally supported by a patient data management system.
期刊介绍：
BMC Health Services Research is an open access, peer-reviewed journal that considers articles on all aspects of health services research, including delivery of care, management of health services, assessment of healthcare needs, measurement of outcomes, allocation of healthcare resources, evaluation of different health markets and health services organizations, international comparative analysis of health systems, health economics and the impact of health policies and regulations.
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