A literature review of organisational, individual and teamwork factors contributing to the ICU discharge process.
OBJECTIVE
It is everyday news that we need more intensive care unit (ICU) beds, thus effective use of existing resources is imperative. The aim of this literature review was to critically analyse current literature on how organizational factors, individual factors and teamwork factors influence the ICU discharge process. A better understanding of discharge practices has the potential to ultimately influence ICU resource availability.


METHODS
Databases including CINAHL, MEDLINE, PROQUEST, SCIENCE DIRECT were searched using key terms such as ICU discharge, discharge process, ICU guidelines and policies, discharge decision-making, ICU organisational factors, ICU and human factors, and ICU patient transfer. Articles' reference lists were also used to locate relevant literature. A total of 21 articles were included in the review.


RESULTS
Only a small number of ICUs used written patient discharge guidelines. Consensus, rather than empirical evidence, dictates the importance of guidelines and policies. Premature discharge, discharge after hours and discharge by triage still exist due to resources constraints, even though the literature suggests these are associated with increased mortality. Teamwork and team training appear to be effective in improving efficiency and communication between professions or between clinical areas. However, this aspect has rarely been researched in relation to ICU patient discharge.


CONCLUSIONS
Intensive care patient discharge is influenced by organisational factors, individual factors and teamwork factors. Organisational interventions are effective in reducing ICU discharge delay and shortening patient hospital stay. More rigorous research is needed to discover how these factors influence the ICU discharge process.
Lin
Frances
F
School of Nursing and Midwifery, Griffith Health, Griffith University, Gold Coast Campus, QLD 4222, Australia. F.Lin@griffith.edu.au
Chaboyer
Wendy
W
Wallis
Marianne
M
D017598:Efficiency, Organizational; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration*; D016134:Organizational Policy; D010348:Patient Care Team / Q000458:organization & administration; D010351:Patient Discharge; D010360:Patient Transfer / Q000458:organization & administration*; D012308:Risk Management