The Experience of a Neurocritical Care Admission and Discharge for Patients and Their Families: A Qualitative Analysis.
Kelly Rath, Natalie Kreitzer, Erika Schlichter and 4 others
PMID 32371682WHAT IT FOUND
Caregivers and survivors of neurocritical illness described discharge as too soon, instructions as unclear, and follow-up as missing.
Many praised ICU care, but post-ICU needs remained. This describes transition gaps, not evidence a discharge intervention works.
Key findings
01Premature discharge was the most commonly coded unmet resource need (12); unclear discharge (11), poor preparation (9), and being ghosted (9) were also common.
02Patients or caregivers with ICU stays over 72 hours or discharge to a skilled nursing facility reported more problems, and those with traumatic brain injury gave fewer positive comments.
03Good ICU care (115 codes), enthusiasm for the institution (33), and gratitude (31) were common positive codes; bad post-ICU care (15), lacking follow-up (15), and recovery needs (15) were common improvement codes.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This was a quality improvement initiative, not a formal clinical observational cohort study. Only 232 of 557 reached patients or caregivers gave qualitative responses, and women and patients with ICU stays under 72 hours were less likely to respond. The study was done at one institution, so discharge processes elsewhere may differ. Responses were collected by telephone 3-6 months after admission, so recall, stress, and injury could affect answers. Different personnel collected data over time, which may have affected willingness to speak. Caregivers answered for some patients who could not speak, so responses may not reflect the patient's own view. The study did not test a discharge intervention or measure patient outcomes.
Declared interests
A portion of the work was funded by the National Institute of Neurological Disorders and Stroke of the National Institutes of Health under Award Number K23NS101123 (BF). None of the authors report relevant conflicts of interest. Dr Kreitzer receives honoraria for speaking from Portola Pharmaceuticals and EM-CREG International.
The easy way to misread this
Do not conclude that a streamlined discharge process improves outcomes. This was a qualitative quality improvement study that asked survivors and caregivers about unmet needs and unanswered questions 3-6 months after admission; it did not test an intervention or measure patient outcomes.