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Table 3 “Process” factors and illustrative quotes

From: A qualitative exploration of the discharge process and factors predisposing to readmissions to the intensive care unit

Communication “A lot of times when we discharge patients, it seems like the nursing-to-nursing report is different than the physician-to-physician report. Nurses are more aware of (things) like when the patient gets up to the commode, they’re very transiently short of breath, whereas physicians might not. So, when the floor nurses now inform the physician about a (transient) desaturation of 80(%), and they’re like, “Well, holy cow, I didn’t get a report on that.” Nurse When somebody’s coming down (from the ICU), I’ll occasionally get a call — maybe a third of the time — from the ICU consultant (physician). That’s worthwhile and beneficial for the higher-level stuff (but) it would be more worthwhile (to focus on) the communication between the nurse who’s dismissing the patient (from the ICU) and the nurse who’s accepting the patient (on the floor) because that’s the generator for most of the (ICU readmissions). (For example) “if they get transiently tachypneic, just suction them and they’ll be fine”. That kind of (communication) would be a higher yield. Consultant Physician My personal observation is a lot of physician assistants and nurses on the floor are afraid to let the consultant know (of a change in patient status), especially when they don’t want to bother him. (They believe) the consultant thinks it’s a sign of weakness. So, the consultants, most of the time don’t get (real time) information (on) what’s happening. Sometimes the nurse is afraid to communicate with the residents. So, they default to the (emergency response) system (as) a safety net.” Resident Physician
Transitions of care “Sometimes it is difficult to get a bed on some floors and (it complicates) trying to find a time when the receiving nurse and myself can meet up and give report and transfer the patient in a safe manner. If myself and the receiving nurse don’t get a very good hand-off and something gets missed or something of that nature, I guess that could somehow lead to them coming back.” Nurse