Delphi study to derive expert consensus on a set of criteria to evaluate discharge readiness for adult ICU patients to be discharged to a general ward — European perspective

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dc.article.number773
dc.contributor.authorHiller, Maike
dc.contributor.authorWittmann, Maria
dc.contributor.authorBracht, Hendrik
dc.contributor.authorBakker, Jan
dc.date.accessioned2022-08-18T16:14:12Z
dc.date.available2022-08-18T16:14:12Z
dc.date.issued2022
dc.description.abstractBackground/purpose: Discharge decisions in Intensive Care Unit (ICU) patients are frequently taken under pressure to free up ICU beds. In the absence of established guidelines, the evaluation of discharge readiness commonly underlies subjective judgements. The challenge is to come to the right decision at the right time for the right patient. A premature care transition puts patients at risk of readmission to the ICU. Delayed discharge is a waste of resources and may result in over-treatment and suboptimal patient flow. More objective decision support is required to assess the individual patient’s discharge readiness but also the current care capabilities of the receiving unit. Methods: In a modified online Delphi process, an international panel of 27 intensive care experts reached consensus on a set of 28 intensive care discharge criteria. An initial evidence-based proposal was developed further through the panelists’ edits, adding, comments and voting over a course of 5 rounds. Consensus was defined as achieved when ≥ 90% of the experts voted for a given option on the Likert scale or in a multiple-choice survey. Round 1 to 3 focused on inclusion and exclusion of the criteria based on the consensus threshold, where round 3 was a reiteration to establish stability. Round 4 and 5 focused on the exact phrasing, values, decision makers and evaluation time frames per criterion. Results: Consensus was reached on a standard set of 28 ICU discharge criteria for adult ICU patients, that reflect the patient’s organ systems ((respiratory (7), cardiovascular (9), central nervous (1), and urogenital system (2)), pain (1), fluid loss and drainages (1), medication and nutrition (1), patient diagnosis, prognosis and preferences (2) and institution-specific criteria (4). All criteria have been specified in a binary decision metric (fit for ICU discharge vs. needs further intensive therapy/monitoring), with consented value calculation methods where applicable and a criterion importance rank with “mandatory to be met” flags and applicable exceptions. Conclusion: For a timely identification of stable intensive care patients and safe and efficient care transitions, a standardized discharge readiness evaluation should be based on patient factors as well as organizational boundary conditions and involve multiple stakeholders.
dc.format.extent14 páginas
dc.fuente.origenAutoarchivo
dc.identifier.citationBMC Health Serv Res 22, 773 (2022)
dc.identifier.doi10.1186/s12913-022-08160-6
dc.identifier.urihttps://doi.org/10.1186/s12913-022-08160-6
dc.identifier.urihttps://repositorio.uc.cl/handle/11534/64672
dc.identifier.wosidWOS:000810675800005
dc.information.autorucEscuela de medicina ; Bakker, Jan ; 0000-0003-2236-7391 ; 237934
dc.language.isoen
dc.nota.accesoContenido completo
dc.pagina.final14
dc.pagina.inicio1
dc.revistaBMC Health Services Research
dc.rightsacceso abierto
dc.rights.holderThe Author(s)
dc.subjectIntensive care unites_ES
dc.subjectAdult patientes_ES
dc.subjectDischargees_ES
dc.subjectAssessmentes_ES
dc.subjectCare transitiones_ES
dc.subjectObjective criteriaes_ES
dc.subjectChecklistes_ES
dc.subjectGeneral wardes_ES
dc.subjectMultidisciplinary teames_ES
dc.subject.ddc610
dc.subject.deweyMedicina y saludes_ES
dc.subject.ods03 Good health and well-being
dc.subject.odspa03 Salud y bienestar
dc.titleDelphi study to derive expert consensus on a set of criteria to evaluate discharge readiness for adult ICU patients to be discharged to a general ward — European perspectivees_ES
dc.typeartículo
dc.volumen22
sipa.codpersvinculados237934
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