title: Barriers and facilitators to improve safety and efficiency of the ICU discharge process: a mixed methods study.
abstract: Evidence indicates that suboptimal clinical handover from the intensive care unit (ICU) to general wards leads to unnecessary ICU readmissions and increased mortality. We aimed to gain insight into barriers and facilitators to implement and use ICU discharge practices.
  
  
  
  A mixed methods approach was conducted, using 1) 23 individual and four focus group interviews, with post-ICU patients, ICU managers, and nurses and physicians working in the ICU or general ward of ten Dutch hospitals, and 2) a questionnaire survey, which contained 27 statements derived from the interviews, and was completed by 166 ICU physicians (21.8%) from 64 Dutch hospitals (71.1% of the total of 90 Dutch hospitals).
  
  
  
  The interviews resulted in 66 barriers and facilitators related to: the intervention (e.g., feasibility); the professional (e.g., attitude towards checklists); social factors (e.g., presence or absence of a culture of feedback); and the organisation (e.g., financial resources). A facilitator considered important by ICU physicians was a checklist to structure discharge communication (92.2%). Barriers deemed important were lack of a culture of feedback (55.4%), an absence of discharge criteria (23.5%), and an overestimation of the capabilities of general wards to care for complex patients by ICU physicians (74.7%).
  
  
  
  Based on the barriers and facilitators found in this study, improving handover communication, formulating specific discharge criteria, stimulating a culture of feedback, and preventing overestimation of the general ward are important to effectively improve the ICU discharge process.
authors.affiliation: Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands. Nelleke.vansluisveld@radboudumc.nl.
authors.forename: Nelleke
authors.initials: N
authors.lastname: van Sluisveld
authors.affiliation: Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
authors.forename: Anke
authors.initials: A
authors.lastname: Oerlemans
authors.affiliation: Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
authors.forename: Gert
authors.initials: G
authors.lastname: Westert
authors.affiliation: Department of Intensive Care Medicine, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
authors.forename: Johannes Gerardus
authors.initials: JG
authors.lastname: van der Hoeven
authors.affiliation: Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
authors.forename: Hub
authors.initials: H
authors.lastname: Wollersheim
authors.affiliation: Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
authors.forename: Marieke
authors.initials: M
authors.lastname: Zegers
mesh_terms: D000328:Adult; D057189:Checklist; D003422:Critical Care / Q000379:methods; D005260:Female; D017144:Focus Groups; D006801:Humans; D007362:Intensive Care Units; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010351:Patient Discharge / Q000592:standards*; D062209:Patient Handoff; D061214:Patient Safety / Q000592:standards*; D010362:Patients' Rooms; D036301:Qualitative Research; D058996:Quality Improvement; D011795:Surveys and Questionnaires
keywords: Critical care; Discharge practices; Intensive care; Intensive care unit; Mortality; Patient readmission