Waiting to be discharged from intensive care units: Key factors shaping patient and family experiences

Objectives: To explore the factors that facilitate and hinder intensive care unit (ICU) discharge processes related to patients and their family members. 

Methods: This was a qualitative exploratory study conducted in three regional adult ICUs in Queensland, Australia. Data were collected through semi-structured interviews with patients and their family members (or patient representatives) in addition to daily reflections based on direct observation. A deductive content analysis was undertaken using the Structure, Process, and Outcomes framework, followed by an inductive approach to generate themes.

Results: A total of 16 participants participated in interviews, involving 14 patients, one family member, and one patient representative. Four themes included a desire to be involved, being kept informed, uncertainty in waiting, and the discharge rush. Participants spoke about the desire to be involved in their care and discharge transition. There was a prevailing tension among patients about being kept informed. Although participants remarked that staff communication was reassuring, supportive, and comforting, they noted that timelines for discharge were often unclear, causing hesitation in the discharge process and minimal information before a sudden transfer. Uncertainty in waiting was frequently mentioned by the participants and also reflected in the daily reflections. This uncertainty led to consequences, such as discharge against medical advice and after-hours discharge rush. 

Conclusion: The findings of this study support existing literature that underlines the importance of patient and family involvement in care, effective communication, and coordination during the discharge processes. After-hours discharge rush should be avoided for the safety of the patients and others on the wards. 

Implications for clinical practice: Gaining an understanding of patient and family perspectives on the ICU discharge processes can guide clinicians in developing strategies to improve the continuity and quality of care and therefore enhance patient safety during ICU discharge.