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Patient recruitment and reasons for exclusion of certain patients. ICU: Intensive care unit; PODS-ICU: Patient-oriented discharge summary tool.
Source publication
Background:
Patients leaving the intensive care unit (ICU) often experience gaps in care due to deficiencies in discharge communication, leaving them vulnerable to increased stress, adverse events, readmission to ICU, and death. To facilitate discharge communication, written summaries have been implemented to provide patients and their families wi...
Context in source publication
Context 1
... these, 42 patients were potentially eligible for the study. Participant recruitment and reasons for exclusion are shown in Figure 2. The most common reasons for patient exclusion were ICU stays less than 24 h in duration (n = 181 patients) and discharges on weekends when the study team (i.e., patient partners) was unavailable to approach patients (n = 57). ...
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Citations
... Whereas the least involvement was in identifying research priorities (n = 5), and being a co-applicant on a research project or grant application (n = 6). Regarding plain language summary, only one out of the 82 studies (1.22%) provided a plain language summary in their paper [20]. ...
Background
In recent years, patient and public involvement (PPI) in research has significantly increased; however, the reporting of PPI remains poor. The Guidance for Reporting Involvement of Patients and the Public (GRIPP2) was developed to enhance the quality and consistency of PPI reporting. The objective of this systematic review is to identify the frequency and quality of PPI reporting in patient safety (PS) research using the GRIPP2 checklist.
Methods
Searches were performed in Ovid MEDLINE, EMBASE, PsycINFO, and CINAHL from 2018 to December, 2023. Studies on PPI in PS research were included. We included empirical qualitative, quantitative, mixed methods, and case studies. Only articles published in peer-reviewed journals in English were included. The quality of PPI reporting was assessed using the short form of the (GRIPP2-SF) checklist.
Results
A total of 8561 studies were retrieved from database searches, updates, and reference checks, of which 82 met the eligibility criteria and were included in this review. Major PS topics were related to medication safety, general PS, and fall prevention. Patient representatives, advocates, patient advisory groups, patients, service users, and health consumers were the most involved. The main involvement across the studies was in commenting on or developing research materials. Only 6.1% (n = 5) of the studies reported PPI as per the GRIPP2 checklist. Regarding the quality of reporting following the GRIPP2-SF criteria, our findings show sub-optimal reporting mainly due to failures in: critically reflecting on PPI in the study; reporting the aim of PPI in the study; and reporting the extent to which PPI influenced the study overall.
Conclusions
Our review shows a low frequency of PPI reporting in PS research using the GRIPP2 checklist. Furthermore, it reveals a sub-optimal quality in PPI reporting following GRIPP2-SF items. Researchers, funders, publishers, and journals need to promote consistent and transparent PPI reporting following internationally developed reporting guidelines such as the GRIPP2. Evidence-based guidelines for reporting PPI should be encouraged and supported as it helps future researchers to plan and report PPI more effectively.
Trial registration
The review protocol is registered with PROSPERO (CRD42023450715).
... The findings extend the current understanding of healthcare resource use, specifically what ICU resources are consumed by patients experiencing homelessness, which can help healthcare providers and healthcare systems plan resources required to treat patients experiencing homelessness in ICUs and as they transition from the ICU to the hospital or discharged to the community. Care pathways and discharge planning has been a successful strategy for managing discharge among the general critical care population and maybe present an opportunity to improve the transition out of the ICU for patients experiencing homelessness [35,48,49]. Future research is needed to explore the potential effectiveness of these strategies, which perhaps need to be initiated earlier among patients experiencing homelessness given the complexity of their situations. ...
Purpose
To understand the epidemiology and healthcare use of critically ill patients experiencing homelessness compared to critically ill patients with stable housing.
Methods
This retrospective population-based cohort study included adults admitted to any ICU in Alberta, Canada, for a 3-year period. Administrative and clinical data from the hospital, ICU and emergency department were used to examine healthcare resource use (processes of care, ICU and hospital length of stay, hospital readmission and emergency room visits). Regression was used to quantify differences in healthcare use by housing status.
Results
2.3% (n = 1086) of patients admitted to the ICU were experiencing homelessness; these patients were younger, more commonly admitted for medical reasons and had fewer comorbidities compared to those with stable housing. Processes of care in the ICU were mostly similar, but healthcare use after ICU was different; patients experiencing homelessness who survived their index hospitalization were more than twice as likely to have a visit to the emergency department (OR = 2.3 times, 95% CI 2.0–2.6, < 0.001) or be readmitted to hospital (OR = 2.1, 95% CI 1.8–2.4, p < 0.001) within 30 days, and stayed 10.1 days longer in hospital (95% CI 8.6–11.6, p < 0.001), compared with those who have stable housing.
Conclusions
Patients experiencing homelessness have different characteristics at ICU admission and have similar processes of care in ICU, but their subsequent use of healthcare resources was higher than patients with stable housing. These findings can inform strategies to prepare patients experiencing homelessness for discharge from the ICU to reduce healthcare resource use after critical illness.
Supplementary Information
The online version contains supplementary material available at 10.1186/s13054-023-04753-7.
... In addition, patient discharge summaries, including nursing summary reports, are used to provide information to patients and their families. [14] These records are expected to become increasingly important. ...
Objective: To clarify the medical care information nurses share among multiple facilities such as hospitals and visiting nursing stations, specialized nursing homes, and geriatric health service facilities in Japan.Methods: The research design was an exploratory survey study. We administered a questionnaire survey to registered nurses with at least three years of clinical experience from August 2020 to September 2021. Data from 257 participants were analyzed using simple tabulation, chi-square test, and univariate and multivariate analyses. Items that could not be addressed by nursing summaries alone included how to interact with patients and families, activities of daily living, and nursing procedures.Results: The results indicate that nurses require information on nursing procedures, how to interact with patients and their families, and care. Essential nursing summary report items included infectious disease, allergy, medications, final bowel movements, and tube feeding. The essential items that varied across facilities were commissioned physicians, patients’ perspectives on the disease, regular medical examinations, and peripheral symptoms.Conclusions: The summary reports were used to exchange information with other nurses, get confirmation of nursing procedures, and get confirmation of the history of the present illness. In the future, they should include customized content depending on the information requirements of each institution. These results can be used as a reference for the nursing summaries sought by recipients, leading to improved quality of care after a transition.
... Access to timely and complete patient data is essential, but training, simulation, and audit and feedback might reduce information omissions and improve how that information is used. Finally, we need to empower patients and family caregivers to be stewards of continuity as they are the only constants in the care journey (44)(45)(46)(47). ...
Objective:
Effective communication between clinicians is essential for seamless discharge of patients between care settings. Yet, discharge summaries are commonly not available and incomplete. We implemented and evaluated a structured electronic health record-embedded electronic discharge (eDischarge) summary tool for patients discharged from the ICU to a hospital ward.
Design:
Multiple baseline trial with randomized and staggered implementation.
Setting:
Adult medical-surgical ICUs at four acute care hospitals serving a single Canadian city.
Patients:
Health records of patients 18 years old or older, in the ICU 24 hours or longer, and discharged from the ICU to an in-hospital patient ward between February 12, 2018, and June 30, 2019.
Intervention:
A structured electronic note (ICU eDischarge tool) with predefined fields (e.g., diagnosis) embedded in the hospital-wide electronic health information system.
Measurements and main results:
: We compared the percent of timely (available at discharge) and complete (included goals of care designation, diagnosis, list of active issues, active medications) discharge summaries pre and post implementation using mixed effects logistic regression models. After implementing the ICU eDischarge tool, there was an immediate and sustained increase in the proportion of patients discharged from ICU with timely and complete discharge summaries from 10.8% (preimplementation period) to 71.1% (postimplementation period) (adjusted odds ratio, 32.43; 95% CI, 18.22-57.73). No significant changes were observed in rapid response activation, cardiopulmonary arrest, death in hospital, ICU readmission, and hospital length of stay following ICU discharge. Preventable (60.1 vs 5.7 per 1,000 d; p = 0.023), but not nonpreventable (27.3 vs 40.2 per 1,000d; p = 0.54), adverse events decreased post implementation. Clinicians perceived the eDischarge tool to produce a higher quality discharge process.
Conclusions:
Implementation of an electronic tool was associated with more timely and complete discharge summaries for patients discharged from the ICU to a hospital ward.
Background
Patient recovery after a critical illness can be protracted, requiring a care continuum that extends along a patient pathway from the critical care unit, hospital ward, and into the community care setting. High-quality care on patient transfer from critical care, including medication safety, is facilitated by education for patients and families, family engagement, support systems, and health care professional (HCP)-patient communication. Currently, uncertainty exists regarding how HCPs can and should engage with critical care patients and family members about their medication.
Research Question
What are the views and experiences of critical care patients and family members about their involvement in, communication about, understanding of, and decision-making related to their medication after transfer from critical care to the hospital ward?
Study Design and Methods
This qualitative study used semistructured interviews, conducted with critical care patients and family members after transfer from critical care to a hospital ward in a large National Health Service hospital trust. Anonymized transcripts of interviews were analyzed thematically using a coding framework developed from understandings of patient and family engagement in medication administration.
Results
Twenty-seven participants (15 patients and 12 family members of patients) completed the interviews. We identified five themes and 15 subthemes, providing an overview of patients’ and family members’ views on medication management during acute illness and ongoing recovery. Themes identified were: impact of acute illness and treatment burden on preexisting illness, preexisting knowledge and capability, beliefs about persons roles and expectations, care continuity and individualized information exchange, and engagement in practice.
Interpretation
This study demonstrated that critical care patients and family members want to engage with HCPs about medication administration. HCPs must take an individualized approach to communication and timing, acknowledging the dynamic interplay between patients and family members, using multimodal forms of communication.
