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Related Experiment Video

Updated: Oct 1, 2025

Cutoff Value of Phase Angle by Bioelectrical Impedance Analysis at Admission as a Prognostic Factor in Patients with Acute Heart Failure
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Patient Harm and Institutional Avoidability of Out-of-Hours Discharge From Intensive Care: An Analysis Using Mixed

Sarah Vollam1,2, Owen Gustafson3, Lauren Morgan4

  • 1Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom.

Critical Care Medicine
|March 4, 2022
PubMed
Summary

Discharging patients from the intensive care unit (ICU) out-of-hours is common and unsafe due to reduced staffing. Facilitating daytime ICU discharge is crucial for patient safety and reducing mortality.

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Area of Science:

  • Critical Care Medicine
  • Patient Safety
  • Healthcare Management

Background:

  • Out-of-hours discharge from intensive care units (ICUs) is linked to increased mortality and readmissions.
  • Understanding the reasons behind these adverse outcomes is crucial for improving patient care.

Purpose of the Study:

  • To map the intensive care unit (ICU) discharge process.
  • To describe the consequences of out-of-hours discharge.
  • To inform practice changes aimed at reducing the impact of nighttime ICU discharges.

Main Methods:

  • Mixed-methods study including case record reviews and semistructured interviews with patients, families, and staff.
  • Functional analysis resonance method used for process mapping.
  • Out-of-hours discharge defined as 16:00 to 07:59 hours.

Main Results:

  • Out-of-hours ICU discharge is prevalent and perceived as unsafe due to reduced staffing and skill mix.
  • Patients discharged out-of-hours often experienced premature discharge, inadequate handover, and failure to recognize or escalate deterioration.
  • Five key interdependent functions for timely ICU discharge were identified: multidisciplinary decision, patient preparedness, bed meeting, bed manager allocation, and ward bed availability.

Conclusions:

  • Significant limitations exist in out-of-hours care for patients discharged overnight from the ICU.
  • Facilitating transfer to the ward before 16:00 is recommended.
  • Implementing support systems for unavoidable after-hours discharges is essential to ensure patient safety.