Improving patient flow from the Department of Critical Care Medicine at Auckland City Hospital to general medical and surgical wards

Abstract

Introduction Intensive care is costly both financially and in human terms. Constantly increasing pressure on healthcare budgets means methods of improving cost efficiency and decreasing adverse effects of prolonged intensive care stays are necessary. It is also essential to have the capacity for rapid admission to intensive care for those who need it. Timely discharge of the patient from intensive care once they are safe to move on to lower level care may be one way of ensuring capacity. Methods Two studies were undertaken to gain information on the scope of discharge delay for medically cleared patients from the general intensive care unit to the general wards of a large tertiary hospital in Auckland New Zealand. The first quantitative study collected facts on numbers and reasons for discharge delay. The second qualitative study identified the perceptions of staff in the unit who manage resources on a day-to-day basis. Results Discharge delay was a significant issue for the unit and the organisation. 17% of patients were affected, with a financial cost of around half a million dollars a year. The delays had a negative impact on relationships between staff, both within and outside of the unit, and decreased job satisfaction. The predominant reason for delays was accommodation issues, followed by staffing issues, then patient flow within the wards. Unit staff felt concern and responsibility for the wellbeing of patients requiring intensive care, particularly if those patients had to wait in another area for an ICU bed to be available. There was a strong underlying belief that there must be capacity to admit acutely critically ill patients to the unit at short notice. The availability of nursing staff to care for a patient was what limited admissions, rather than the availability of physical beds or space. Most staff believe that discharge delay can be beneficial for many patients; however, there are associated risks, the most prominent being psychological dependence and ICU psychosis.