Audit of ICU discharge practices to the ward 

Who
50 patients discharged from ICU to the ward

How    
Data collection form (Google Docs) completed by ICU outreach team at time of ward review post discharge
https://docs.google.com/forms/d/1L4Nc67Ua4A26yv4i5gbVOjd7SrOeDxZyML0A7hY4Bx0/edit? sp=forms_home&ths=true

When    
Six monthly

Why    
To audit the adherence to processes required to safely transfer ICU patients to the ward - 

1. Discharge sticker
2. Discharge summary
3. Resuscitation planning
4. Advance care planning (where applicable)
5. Cessation of ICU specific electrolyte replacement prescriptions 

     
To identify any preventable systemic delays in patients who are discharged from ICU to the ward.  There is a probable association between the time spent unnecessarily for patients in ICU and morbidity, as well as being an unnecessary use of resources. 

Reporting    
At the completion of each audit, the ICU registrar will-

1. Report to the ICU morbidity and mortality meeting
2. Report to the ED morbidity and mortality meeting
3. Provide a written report 
4. Recommend any changes to the audit including data collection and reported outcomes

Outcomes    
Process indicators

1. Proportion of discharge stickers being adequately completed (including individual elements of the discharge sticker)
2. Proportion of discharge summaries that are filed in the discharged patient’s medical record, with additional audit of: 

• Proportion of elements completed in the discharge summary
• Clinical handover
• Management plan(s) post ICU
• Resuscitation planning outcomes

Outcome indicators
Audit of specific elements of the discharge summary such as:

Documented times of:   (Information source)
​   (a) Patient being cleared for ward discharged    (ICU observation chart)
   (b) Ward bed allocated   (Patient flow co-ordinator)
   (c) Ward bed available   (Patient flow co-ordinator)
   (d) ICU departure   ​(AORTIC database)

​Median times between:
(a) and (b)
(b) and (c)
(c) and (d)