Table 1.

Summary of data abstraction for themes, and facilitators and barriers to a successful transition in care

Theme	Example
ICU Discharge Themes
Adverse events, readmission, and mortality following discharge	ICU or emergency department readmission rates; Mortality following ICU discharge in a given time frame (e.g., one year after discharge)
Patient and family needs and experiences during discharge	Patients or families desire for more information about the next steps in care; Appreciation for the attentiveness of nursing staff in ICU
Planning for discharge	Notifying subsequent care providers about the patient’s condition; Aligns with planning for discharge in the phase of care model
Continuity of patient care	Use of a transition program or follow-up clinics—patients understand where to seek care after ICU discharge
Discharge education for patients and families	Programs that provide information on what is to be expected after discharge and when to seek medical help
Standardizing the discharge process	Use of guidelines or protocols to ensure the discharge process is the same for all patients
Availability of complete and accurate discharge information	Use of medical records, checklists, or summaries to provide appropriate information to either healthcare providers, family members, or patients
Evaluating patient readiness for discharge	Use of clinical scoring assessments to determine severity of illness, marked progress in patient condition; Aligns with phase of care examined
Anxiety associated with discharge	Patient or family feelings of anxiousness about transitioning to a different level of care or worrying about leaving the ICU
Timeliness of discharge	Time of day discharge occurs (daytime versus nighttime), and if there is a delay in discharge (patient has been ready for discharge for several days but has not been transitioned out of ICU)
Resource use during discharge	Use of supplies, infrastructure, or staff time to facilitate the discharge
Critical care transition program	Presence of a dedicated team that works with ICU and the receiving care providers to improve the transition. May include a nurse liaison or outreach team
Medication reconciliation	Verifying that medications started in the ICU should be continued after discharge
Autonomy	Patients feeling like they have a say in their discharge and/or subsequent care
Discharge education for providers	Programs that teach ward staff what to expect from an ICU patient; Education for ICU providers about facilitating a successful ICU discharge
Facilitators for a successful ICU discharge
Patients and family	Discharge education for patients and families; Family engagement/support system; Provider-patient communication; Patient demographic and clinical characteristics; Written communication for patients and families; Expectations of patients/family; Patient/family are treated as members of the healthcare team; Patient/family feelings of self-efficacy; Use of coping mechanisms; Excited, joyous to be leaving the ICU
Healthcare providers	Provider-provider communication; Critical care transition programs (e.g., outreach, liaison nurse); Collaboration between ICU and ward; Written documentation for providers; Knowledge/experience of provider; Clinical judgment or decision-making; Clear roles/responsibility for providers; Multidisciplinary team; Provider leadership; Provider empathy to patient and family
Organization	Tools to facilitate discharge; Impact of current discharge practices on flow and performance; Guidelines or policies; Use of best practices; Discharge location from ICU; Education/training of providers; Time of discharge (day of week or time of day); Availability of follow-up clinics or home support programs; Admission location before ICU; Hospital characteristics (e.g., trauma level);
Barriers to a successful ICU discharge
Patients and family	Patient demographic and clinical characteristics; Feelings of patient and family anxiety, embarrassment; Expectations of patients/family; Physical and psychological effects of illness (e.g., pain, nightmares; Lack of provider-patient communication; ICU and hospital length of stay; Financial obstacles (lack of insurance, cost of care); Socioeconomic factors of patient/ family; Logistical barriers to providing support (e.g., family lives far from hospital); Lack of familial support; Feelings of lack of control
Healthcare providers	Provider workload; Lack of provider-provider communication; Lack of knowledge/experience of provider; Provider anxiety
Organization	Impact of current discharge practices on flow and performance; Delay in discharge; Time of discharge (day of week or time of day); Limited ICU and ward resources; Costs of healthcare provided; Hospital characteristics (e.g., trauma level); Hospital or ICU capacity; Admission location before ICU; Physical and technological infrastructure (small patient rooms, no electronic health records; Lack of education/training of providers; Reduction in the levels of technology and monitoring when transition from ICU to ward; Restricted visitation policies