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dc.contributor.authorVollam, Sarah
dc.contributor.authorPattison, Natalie
dc.contributor.authorThomas, Hilary
dc.contributor.authorGustafson, Owen
dc.contributor.authorWatkinson, Peter
dc.contributor.authorMorgan, Lauren
dc.date.accessioned2022-03-15T16:30:02Z
dc.date.available2022-03-15T16:30:02Z
dc.date.issued2022-03-07
dc.identifier.citationVollam , S , Pattison , N , Thomas , H , Gustafson , O , Watkinson , P & Morgan , L 2022 , ' Patient harm and institutional avoidability of out-of-hours discharge from intensive care: An analysis using mixed methods ' , Critical Care Medicine . https://doi.org/10.1097/CCM.0000000000005514
dc.identifier.issn0090-3493
dc.identifier.otherPURE: 26800527
dc.identifier.otherPURE UUID: a369631f-bea8-4399-b896-47aada312665
dc.identifier.otherORCID: /0000-0002-2072-7827/work/110097007
dc.identifier.otherORCID: /0000-0002-6771-8733/work/110097128
dc.identifier.urihttp://hdl.handle.net/2299/25434
dc.description© [2022] The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY). https://creativecommons.org/licenses/by/4.0/
dc.description.abstractObjective: Out-of-hours discharge from ICU to the ward is associated with increased in-hospital mortality and ICU readmission. Little is known about why this occurs. We map the discharge process and describe the consequences of out-of-hours discharge to inform practice changes to reduce the impact of discharge at night. Design: This study was part of the REFLECT mixed methods study. We defined out-of-hours discharge as 16:00 - 07:59h. We undertook 20 in-depth case record reviews where in-hospital death after ICU discharge had been judged ‘probably avoidable’ in previous retrospective structured judgement reviews, and 20 where patients survived. We conducted semi-structured interviews with 55 patients, family members and staff with experience of ICU discharge processes. These, along with a stakeholder focus group, informed ICU discharge process mapping using the Human Factors-based Functional Analysis Resonance Method (FRAM). Setting: Three UK NHS hospitals, chosen to represent different hospital settings. Subjects: Patients discharged from ICU, their families and staff involved in their care. Interventions None. Measurements and Main Results: Out-of-hours discharge was common. Patients and staff described out-of-hours discharge as unsafe due to a reduction in staffing and skill mix at night. Patients discharged out-of-hours were commonly discharged prematurely, had inadequate handover, were physiologically unstable and did not have deterioration recognised or escalated appropriately. We identified five interdependent functions key to facilitating timely ICU discharge: multi-disciplinary team decision for discharge; patient prepared for discharge; bed meeting; bed manager allocation of beds; and ward bed made available. Conclusion: We identified significant limitations in out-of-hours care provision following overnight discharged from ICU. Transfer to the ward before 16:00 should be facilitated where possible. Our work highlights changes to help make day time discharge more likely. Where discharge after 16:00 is unavoidable, support systems should be implemented to ensure the safety of patients discharged from ICU at night.en
dc.format.extent10
dc.language.isoeng
dc.relation.ispartofCritical Care Medicine
dc.rightsOpen
dc.titlePatient harm and institutional avoidability of out-of-hours discharge from intensive care: An analysis using mixed methodsen
dc.contributor.institutionDepartment of Adult Nursing and Primary Care
dc.contributor.institutionSchool of Health and Social Work
dc.contributor.institutionPatient Experience and Public Involvement
dc.description.statusPeer reviewed
dc.relation.schoolSchool of Health and Social Work
dc.description.versiontypeFinal Published version
dcterms.dateAccepted2022-03-07
rioxxterms.versionVoR
rioxxterms.versionofrecordhttps://doi.org/10.1097/CCM.0000000000005514
rioxxterms.licenseref.urihttp://creativecommons.org/licenses/by/4.0/
rioxxterms.typeJournal Article/Review
herts.preservation.rarelyaccessedtrue
herts.rights.accesstypeOpen


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