Contextual Factors Influencing Intensive Care Patients' Discharge Processes: A Multicentre Prospective Observational Study

Aims: To compare contextual factors influencing discharge practices in three intensive care units (ICUs).

Design: A prospective observational study.

Methods: Data were collected using a discharge process report form (DPRF) between May and September 2023. Descriptive statistics were performed to analyse demographic and clinical data. One-way analysis of variance (ANOVA) was used to test the time interval differences among the three sites.

Results: Overall, 69 patients' discharge processes were observed. Among them, 41 (59%) experienced discharge delay, and 1 in 5 patients experienced after-hours discharge. There were statistically significant differences in mean hours in various time intervals during the discharge processes among the three sites. Patients in Hospital C waited the longest time (mean = 31.9 h) for the ward bed to be ready after the bed was requested and for being eventually discharged after ICU nurses to get them ready for discharge (mean = 26.7 h) compared to Hospital A and Hospital B.

Conclusions: We found that discharge delay and after-hours discharge were common and there were significant differences in mean hours of various time intervals during the discharge processes occurred among the three sites. The influence of contextual factors in different hospitals/ICU needs to be considered to improve the ICU discharge process.

Implications for the profession and/or patient care: Researchers and clinicians should consider targeted context-specific interventions and strategies to optimise patient discharge process from ICUs.

Impact: The study findings will inform the development of tailored interventions to reduce the discharge delay and after-hours discharge and, in turn, improve the quality and safety of patient care and health service efficiency.

Reporting method: The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines.

Patient or public contribution: Patients' discharge processes were observed, and consumer representatives were involved in the study design.