Improving critical care discharge summaries: a collaborative quality improvement project using PDSA.

Area of Science:

• Healthcare Quality Improvement
• Patient Safety
• Critical Care Medicine

Background:

• Approximately 110,000 individuals annually require intensive care unit (ICU) care in England and Wales.
• Patient transfer from ICU to general wards presents risks due to changes in healthcare providers and environment.
• General ward nurses experience anxiety and uncertainty when managing patients transitioning from critical care.

Purpose of the Study:

• To enhance the quality of critical care discharge summaries.
• To improve the transition of care for patients moving from critical care to general wards.
• To implement and evaluate an enhanced capability critical care outreach service (iMobile).

Main Methods:

• A collaborative, evidence-based quality improvement project utilizing Plan, Do, Study, Act (PDSA) methodology over three cycles.
• Methods included literature reviews, process mapping, staff focus groups, patient storytelling, and regular discharge summary audits.
• Behavior change interventions comprised audit and feedback, patient experience feedback, and education by local opinion leaders.

Main Results:

• Audit results for discharge summary quality were mixed throughout the project, indicating challenges in sustaining positive change.
• Fluctuating ICU bed occupancy and staff turnover impacted workload and the integration of new staff, affecting consistency.
• The project highlights the difficulties in maintaining improvements in discharge summary quality within a dynamic critical care environment.

Conclusions:

• Sustaining improvements in critical care discharge summaries is challenging due to operational pressures and staff changes.
• The iMobile initiative and quality improvement project provided valuable insights into enhancing patient care transitions.
• Lessons learned offer recommendations for future quality improvement initiatives in critical care and patient discharge processes.