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A strategy to enhance the safety and efficiency of handovers of ICU patients: study protocol of the pICUp study

机译：提高ICU患者移交安全性和效率的策略：pICUp研究的研究方案

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Background To use intensive care unit (ICU) facilities efficiently and ensure high quality of care, an optimal patient flow is necessary. Discharging patients relieves the pressure on ICU beds but the risk of premature discharge must be managed carefully. Suboptimal patient discharge may result in ICU readmissions and in patients’ death. The aim of this study is to obtain insight into the safety and efficiency of current ICU discharge practices and into barriers and facilitators to the implementation of effective ICU discharge interventions, and to develop an implementation strategy tailored to the barriers and facilitators identified. Methods/design This study exists of five phases. Phase A: analysis of routinely registered data on variation in ICU readmissions and hospital mortality after ICU discharge of all ICUs participating in the Dutch National Intensive Care Evaluation registry (n?=?83). Phase B: systematic review of effective interventions aiming to improve the efficiency and safety of the ICU discharge process. Phase C: assessing the intervention adherence with a questionnaire survey among all Dutch ICUs (n?=?90). Phase D: assessing barriers and facilitators to the implementation of effective ICU discharge interventions with a questionnaire survey among all Dutch intensivists (n?=?700). The questionnaire will be based on barriers and facilitators identified by focus groups (n?=?4) and individual interviews with professionals of ICUs and general wards and adult discharged ICU patients (n?=?25 to 30). Phase E: systematic development of an implementation strategy based on the sampled data in phase A to D, and effective implementation strategies from the literature using the intervention mapping method. Discussion Using theory and empirical data, an implementation strategy will be developed to improve the safety and efficiency of the ICU discharge process. The developed strategy will be evaluated in a subsequent study. The knowledge obtained in this study should be used for further implementation of ICU discharge interventions, and can be used for implementation of handover interventions in other healthcare transition settings.
机译：背景技术为了有效地使用重症监护病房（ICU）设施并确保高质量的护理，需要最佳的患者流量。出院患者可以减轻ICU病床的压力，但必须谨慎管理过早出院的风险。患者出院不佳可能导致ICU再入院并导致患者死亡。这项研究的目的是了解当前ICU排放实践的安全性和效率，并了解实施有效ICU排放干预措施的障碍和促进者，并制定针对已确定的障碍和促进者的量身定制的实施策略。方法/设计这项研究分为五个阶段。 A阶段：对参加荷兰国家重症监护评估注册中心的所有ICU出院后，ICU入院率和医院死亡率变化的常规注册数据进行分析（n == 83）。阶段B：系统评估有效干预措施，旨在提高ICU放电过程的效率和安全性。阶段C：通过对所有荷兰ICU进行问卷调查来评估干预依从性（n？=？90）。阶段D：通过对所有荷兰强化科医生进行问卷调查，评估实施有效ICU出院干预措施的障碍和促进因素（n = 700）。问卷将基于焦点小组确定的障碍和促进者（n = 4）以及对ICU和普通病房的专业人员以及成年出院的ICU患者进行的个人访谈（n = 25至30）。 E阶段：基于A到D阶段的采样数据系统地制定实施策略，并使用干预映射方法从文献中获得有效的实施策略。讨论使用理论和经验数据，将制定实施策略以提高ICU放电过程的安全性和效率。制定的策略将在后续研究中进行评估。在这项研究中获得的知识应该用于进一步实施ICU出院干预措施，并可以用于在其他医疗过渡环境中实施移交干预措施。

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