How well do we transition patients from ICU to the ward? Let our patients tell us

A practical approach to establishing a critical care outreach service: An expert panel research design

BACKGROUND

For over two decades, nurse-led critical care outreach services have improved the recognition, response, and management of deteriorating patients in general hospital wards, yet variation in terms, design, implementation, and evaluation of such services continue. For those establishing a critical care outreach service, these factors make the literature difficult to interpret and translate to the real-world setting.

AIM

The aim of this study was to provide a practical approach to establishing a critical care outreach service in the hospital setting.

METHOD

An international expert panel of clinicians, managers, and academics with experience in implementing, developing, operationalising, educating, and evaluating critical care outreach services collaborated to synthesise evidence, experience, and clinical judgment to develop a practical approach for those establishing a critical care outreach service. A rapid review of the literature identified publications relevant to the study. A modified Delphi technique was used to achieve expert panel consensus particularly in areas where insufficient published literature or ambiguities existed.

FINDINGS

There were 502 publications sourced from the rapid review, of which 104 were relevant and reviewed. Using the modified Delphi technique, the expert panel identified five key components needed to establish a critical care outreach service: (i) approaches to service delivery, (ii) education and training, (iii) organisational engagement, (iv) clinical governance, and (v) monitoring and evaluation.

CONCLUSION

An expert panel research design successfully synthesised evidence, experience, and clinical judgement to provide a practical approach for those establishing a critical care outreach service. This method of research will likely be valuable in other areas of practice where terms are used interchangeably, and the literature is diverse and lacking a single approach to practice.

Patient experiences of an intensive care Liaison Nurse support service

OBJECTIVES

To illuminate patients' experiences of being a part of an liaison nurse support service focused on supporting recently transferred intensive care unit patients.

RESEARCH METHODOLOGY/DESIGN

A qualitative inductive descriptive design including in-depth interviews was chosen.

SETTING

A project including an liaison nurse support service-intervention was undertaken during a 16-week period at a University hospital in Sweden. The liaison nurse support service was available Monday-Friday 10 am - 6 pm and nurses visited the patient 1-4 times after transfer to the ward.

MAIN OUTCOME MEASURES

Of the 109 patients who were visited by the liaison nurse support service, 14 agreed to be interviewed about their experiences of the transfer. Data was analysed by inductive content analysis.

FINDINGS

One overall theme, An advocate in a vulnerable situation emerged from the data. Four subthemes were identified: Ensures transfer of information between the intensive care unit and the general ward, Makes the circumstances understandable and coordinates between the care levels and Offers emotional support and stability in an uncertain situation.

CONCLUSION

The liaison nurse support service contributed to ensuring accurate transfer of information, solved problems when the patient themselves did not have control or strength and provided emotional support.