Critically ill patients require complex care and experience unique needs during and after their stay in the intensive care unit (ICU). Discharging or transferring a patient from the ICU to a hospital ward or back to community care (under the care of a general practitioner) includes several elements that may shape patient outcomes and overall experiences. The aim of this study was to answer the question: what elements facilitate a successful, high-quality discharge from the ICU? This scoping review is an update to a review published in 2015. We searched MEDLINE, EMBASE, CINAHL, and Cochrane databases from 2013-December 3, 2020 including adult, pediatric, and neonatal populations without language restrictions. Data were abstracted using different phases of care framework models, themes, facilitators, and barriers to the ICU discharge process. We included 314 articles from 11,461 unique citations. Two-hundred and fifty-eight (82.2%) articles were primary research articles, mostly cohort (118/314, 37.6%) or qualitative (51/314, 16.2%) studies. Common discharge themes across all articles included adverse events, readmission, and mortality after discharge (116/314, 36.9%) and patient and family needs and experiences during discharge (112/314, 35.7%). Common discharge facilitators were discharge education for patients and families (82, 26.1%), successful provider-provider communication (77/314, 24.5%), and organizational tools to facilitate discharge (50/314, 15.9%). Barriers to a successful discharge included patient demographic and clinical characteristics (89/314, 22.3%), healthcare provider workload (21/314, 6.7%), and the impact of current discharge practices on flow and performance (49/314, 15.6%). We identified 47 discharge tools that could be used or adapted to facilitate an ICU discharge. Several factors contribute to a successful ICU discharge, with facilitators and barriers present at the patient and family, health care provider, and organizational level. Successful provider-patient and provider-provider communication, and educating and engaging patients and families about the discharge process were important factors in a successful ICU discharge.

中文翻译：

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重症监护患者出院：更新范围审查，以确定提供高质量护理的工具和实践


重症患者在重症监护病房 (ICU) 期间和之后需要复杂的护理并经历独特的需求。将患者从 ICU 出院或转移至医院病房或返回社区护理（在全科医生的护理下）包括几个可能影响患者治疗结果和整体体验的因素。本研究的目的是回答以下问题：哪些因素有助于成功、高质量地从 ICU 出院？这篇范围界定综述是对 2015 年发表的综述的更新。我们检索了 2013 年至 2020 年 12 月 3 日的 MEDLINE、EMBASE、CINAHL 和 Cochrane 数据库，包括成人、儿童和新生儿人群，没有语言限制。使用护理框架模型、主题、促进因素和 ICU 出院过程的障碍的不同阶段提取数据。我们收录了来自 11,461 次独特引用的 314 篇文章。 258 篇 (82.2%) 文章是主要研究文章，大部分是队列研究 (118/314, 37.6%) 或定性研究 (51/314, 16.2%)。所有文章的常见出院主题包括出院后的不良事件、再入院和死亡率（116/314，36.9%）以及出院期间患者和家庭的需求和经历（112/314，35.7%）。常见的出院促进因素包括对患者和家属的出院教育（82，26.1%）、成功的提供者与提供者之间的沟通（77/314，24.5%）以及促进出院的组织工具（50/314，15.9%）。成功出院的障碍包括患者人口统计和临床特征 (89/314, 22.3%)、医疗保健提供者的工作量 (21/314, 6.7%) 以及当前出院实践对流程和绩效的影响 (49/314, 15.6%) ）。 我们确定了 47 种可用于或改造以促进 ICU 出院的出院工具。成功出院有几个因素，其中包括患者及其家人、医疗保健提供者和组织层面的促进因素和障碍。成功的提供者与患者以及提供者与提供者之间的沟通，以及对患者和家属进行有关出院过程的教育和参与，是 ICU 成功出院的重要因素。