Transition of care at discharge from the Intensive Care Unit: a scoping review.
Michele Elisa Weschenfelder Hervé, Paula Buchs Zucatti, Maria Alice Dias Da Silva Lima
PMID 32696919WHAT IT FOUND
ICU-to-ward handoffs varied widely.
Night or weekend discharge and poor communication were linked to more readmissions and deaths, while pharmacist medication review and ICU follow-up helped some outcomes. No single discharge strategy was proven.
Key findings
01Discharge at night or on weekends was listed as a negative factor and was associated with readmission and mortality in some included studies.
02Pharmacist medication review before transfer may reduce medication-related problems, but its effect on mortality, length of stay or ICU readmission was inconclusive.
03Post-discharge follow-up by ICU team members showed a decrease in hospital stay and ICU readmission rate in quantitative assessment.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
It maps evidence rather than testing one intervention, so it cannot tell you which practice works best. The 37 included studies were very different in design and outcomes, so direct comparison is difficult. More than 50% of the studies came from the United States, Canada, Australia and New Zealand, so local ICU-to-ward systems may differ. Only published English, Spanish or Portuguese studies from 2014 to 2018 were included, and reviews and grey literature were excluded. The authors' labeling of practices as positive or negative was partly subjective because many studies did not report outcomes clearly.
Declared interests
The paper reports support from CNPq, Brazil, and says it was extracted from a master's thesis; no other conflict statement is given.
The easy way to misread this
Do not read this review as proof that any one ICU discharge strategy improves patient outcomes. The included studies were heterogeneous, many findings were associations, and the authors state the link between transition practices and outcomes is inconclusive.