Bendigo Health ICU Manual
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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)
  • Home
  • Administration
    • Team members
    • Useful contacts
    • Orientation >
      • ICU Orientation PPT 2019
      • ICU Orientation Guide 2019 >
        • Unit description, inl. contacts, unit details and nursing support
        • Duty Hours
        • Expectations
        • Lines of Responsibility
        • Hospital at Night
        • ICU to Ward patient discharge process - flowchart
        • Ward Rounds
        • Ongoing patient management: prescribing, investigations
        • MET calls
        • Deaths in ICU
        • Clinical Performance meeting preparation
        • Bendigo Health ICU Manual
        • ICU Hub
        • Research
        • Dress code
        • Infection Control
        • Procedures
        • Intubation
        • Education & Learning opportunities
        • Admissions & Refusals
        • Phones & Pagers
        • National Safety and Quality Health Service Standards
        • Unit Guide: Feedback & Disclaimers
        • Disclaimer
        • HMO Learning Objectives
      • ICU ROVER 2019 >
        • Introduction
        • Unit description and Key Contacts
        • HMO Schedule: ward rounds and handovers
        • HMO responsibilities: admissions & discharges
        • Rostering & Education
        • Common medical conditions managed in ICU
        • Useful resources
        • Basic rules
      • ICU Consultant Orientation Guide 2019 >
        • Structure of Bendigo Health
        • Administration in ICU
        • Clinical >
          • Clinical (introduction)
          • Referrals
          • Clinical Documentation - Admissions & Discharges
          • Deaths in ICU
          • External transfers
          • St John of God ICU (SJOG)
          • Structure of the day
          • Ward Rounds & Handover
          • Interface with other units
          • Clinical Management - local practices >
            • Introduction
            • Respiratory
            • Cardiovascular
            • Renal / CRRT
            • Nutrition
            • Endocrine
            • Infection and antimicrobials
            • Care bundles
            • Resuscitation and Advanced Care Planning
            • Analgesia
          • Outreach responsibilities >
            • Introduction
            • Follow up clinic
        • Non-clinical expectations >
          • Introduction & Portfolios
          • Mandatory competencies
          • Professional Development Reviews (PDRs)
          • Meetings
      • Orientation & Guides (downloadable versions)
    • App user tips >
      • FindMyShift
      • Kronos
      • Synapse
    • VHIMS >
      • VHIMS Resources (intranet only)
      • How to enter a VHIMS (intranet only)
    • Social Media Etiquette
    • BASIC equipment loan
    • ICU Consultants Only >
      • Echuca Telehealth Consults
      • Shift swap form for consultants
      • Electronic TiL request form
      • CME Claim Process
  • Clinical
    • Admissions & Discharges >
      • Admissions & Discharges
      • Guideline to Surgical Admissions
    • Daily ICU review & care >
      • FAST HUGS IN BED PLEASE
      • Oxygen prescribing
      • Oxygen - Paediatric considerations
      • Care of the Invasively Ventilated Patient – Adult Patient (PROMPT)
      • Assessing for extubation
      • Nutrition in ICU
      • Thiamine prescribing
      • Patient Diaries
    • Drugs & Infusions >
      • Inpatient prescribing practices
      • Common ICU Drugs
      • Drug Infusions A-Z
      • Drugs by system/action >
        • Antibiotics
        • Diuretics
        • Antithrombotic therapy
        • Analgesics in ICU
        • Antipyretic
        • Anticonvulsants
        • Antiplatelets
        • Antihypertensives
        • Beta-blockers
        • Neuromuscular Blocking Agents
        • Aperients / Laxatives
        • Prokinetics
    • Care bundle >
      • Post-cardiac arrest care (TTM) (PROMPT)
      • Care of the Post-Operative Patient
      • Spinal Trauma- CPG's (includes cervical spine clearance) (PROMPT)
      • Management Of Uncontrolled, Life Threatening Bleeding (Massive Exsanguination) (PROMPT)
    • Clinical Protocols + Guidelines >
      • Approach to patient with suspected influenza
      • RAPID INFLUENZA AND RSV TESTING
      • Stroke Protocol (SCV Oct 2018)
    • NIV >
      • Domiciliary (Home) non-invasive ventilation (NIV)/CPAP patients
      • NIV (PROMPT)
    • Tracheostomy Management
    • PICCO decision making tree
    • CRRT
    • Procedures
    • The Dying Person in ICU >
      • Care of the Dying Patient
      • Organ & Tissue Donation
    • Patient transfers >
      • Emergency calls to the helicopter pad
      • Transferring ICU patients >
        • Intra & Interhospital transfers
        • MRI transfers - special considerations
    • Welfare & other supports for patients and family >
      • Visiting times
      • Social work, pastoral care & aboriginal hospital liaison officer support
      • Interpreter services
      • Patient relations office
  • Beyond Clinical
    • Education & Training >
      • Education & Training >
        • Learning and Training in ICU
        • CICM Primary Exam education
        • Curated educational videos & websites >
          • Virtual bronchoscopy
        • Mandatory training for medical staff
      • Term Assessments >
        • Registrar Assessments and In-Training Evaluation Reports (ITERs)
        • Registrar term assessments (consultant access only) >
          • Term Assessment form (consultant access only)
      • Procedures and Skills Competency Assessments >
        • Bendigo Health ICU DOPS
        • CICM CVC WCA
        • CICM Tracheostromy WCA
        • CICM Pleural Drain WCA
        • CICM Ventilation WCA
        • CICM ALS & BLS WCA
        • CICM Communication WCA
        • CICM Brain Death WCA
        • CICM OCA
        • ANZCA DOPS
        • ACEM DOPS
      • Echocardiography in ICU
      • BASIC Provider & Instructor Courses
      • Paediatric BASIC Provider & Instructor Courses
      • Other education opportunities
      • Paediatric crit care education
      • Useful learning links
    • Research & Quality >
      • Research >
        • STARRT AKI
        • SuDDICU
        • PLUS study
        • Recent Publications
    • Well-being >
      • Mentorship
      • Looking after yourself and colleagues
  • Paediatric ICU
    • Introduction
    • GO NOW Criteria
    • Admission criteria for paediatric HDU/ICU
    • Commonly used SCV Paediatric Guidelines >
      • Asthma
      • Bronchiolitis >
        • Bronchiolitis
        • Respiratory Distress Score for monitoring patients with bronchiolitis on HFNC and CPAP
      • Croup
      • Diabetic ketoacidosis >
        • Algorithm for the management of DKA (to be read in conjunction with SCV guideline)
        • SCV - Diabetic ketoacidosis
      • Seizures >
        • Febrile seizures
        • Non-febrile seizures
      • The Septic Child >
        • Assessment & Management (SCV)
        • Criteria for rapid ICU admission of children with sepsis
      • Dehydration >
        • Dehydration
        • IV fluid management
    • Paediatric Crit Care Education >
      • ED/Paeds education sessions
      • Paediatric equipment 'treasure hunt'
      • Curated paediatric educational videos
      • Other paediatric crit care education opportunities
    • Paediatric Resus Card
  • Emergency!
    • Code Blue: ALS algorithms >
      • Adult ALS algorithm
      • Paediatric ALS algorithm
      • Obstetric cardiac arrest flowchart
    • Emergency algorithms/mnemonics >
      • Airway
      • Breathing
      • Circulation >
        • Management Of Uncontrolled, Life Threatening Bleeding (Massive Exsanguination) (PROMPT)
      • Disability
    • MET calls: common scenarios >
      • Staff concern
      • The Dying Patient
      • Hypoxic Type 1 Respiratory Failure
      • Hypercapnoeic Type 2 Respiratory Failure
      • Atrial Fibrillation
      • Hypotension and CV Shock
      • Altered consciousness
      • The Agitated Patient
      • Oliguria/Anuria
    • MET calls: resources
    • Paediatric Resus Card