ITU Discharge Audit
Mark Smithies – Consultant
Shabana Anwar – Advanced Trainee
Brian Johnston – AFP1
May 2013
Introduction
• Increased morbidity and mortality
• Complex process
• Exchange of information
• Foundation doctors role
To audit patient discharge from the Intensive Care Unit for
compliance with National Institute for Health and Clinical
Excellence (NICE) CG50 guidelines: ‘Acutely ill patients in hospital:
recognition of and response to acute illness of adults in hospital.’
CG50 – Critical care guidelines
Methodology
• 40 patients in audit
• Duration: 8 weeks
• February and March
• Survey of foundation doctors via eportfolio
Audit criterion One: Consultant to consultant referral
For those patients admitted to a critical care area, the percentage of patients for whom
there is evidence that the decision to admit was made by both the consultant caring for the
patient on the ward and the consultant in critical care
7%
YES
NO
n (%)
93%
YES
NO
37 (93%)
3 (7%)
Audit criterion two: Out of hours discharge
Transfer of patients from critical care areas to general wards:
For those patients transferred from a critical care area back to a general ward, the
percentage for whom this transfer occurred between 22.00 and 07.00.
3%
10%
YES
NO
NR
n (%)
85%
YES
NO
NR
4 (10%)
34
(85%)
2 (5%)
Audit criterion three: Formal verbal handover
Care on the general ward following transfer
Percentage of patients for whom there is a formal structured handover of care from critical
care area staff to ward staff (including both medical and nursing staff), supported by a
written plan.
YES
27%
NO
YES
n (%)
73%
NO
29 (73%) 11 (22%)
Audit criterion four: Written management plan
Care on the general ward following transfer
Percentage of patients for whom there is a formal structured handover of care from critical
care area staff to ward staff (including both medical and nursing staff), supported by a
written plan.
YES
NO
32%
Do you find the discharge summaries useful?
68%
YES
n (%)
NO
27 (68%) 13 (32%)
Are the discharge summaries easily accessible in
the patients notes?
Audit criterion 5
Care on the general ward following transfer
Summary of the critical care stay, including diagnosis and treatment, monitoring and
investigation plan
Agreed limitations of treatment
Physical and rehabilitation needs
Psychological and emotional needs
Specific communication or language needs.
Foundation year comments
A summary of relevant history and the admission, but
particularly the specific needs which warranted ITU
admission; how they have responded on the unit, and a
plan for what to do if those problems recur and most
specifically whether they are a candidate for readmission to ITU
These patients arriving on the ward from ITU
tend to need more care than those on the ward
for the first few days as the general ward staff ask
more questions about their care and they are
more concerned about small changes in obs etc
even if still within normal limits
When I've been handed over patients often
important information has been missed out its literally just "just to let you know they're
being discharged"
Levels of re-escalation (if applicable) + any
discussions with family surrounding these +
DNACPR views/status.
Improving handover process
• SBAR
• Generic Letters and Clinical Portal
• Quality control
• Conversion to ward documentation prior to
discharge