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Table 5 “Organizational” factors and illustrative quotes

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

Resource Constraints “In this hospital, when you try to find factors that (related to) bounce back to intensive care unit, your results would be largely influenced by the fact that we don’t have an intermediate care unit. So, if you have a patient with chronic atrial fibrillation, and he’s an outpatient with heart rates of 110, 115 — and in this hospital, having a heart rate of 115 without any other symptoms is a criterion to transfer you to the intensive care unit, and we know that there are outpatient physicians who are comfortable managing (atrial fibrillation) in this setting, even with some observation.” Resident Physician “Nursing resources (play a role). I don’t know (floor nurses) feel they have the resources to check on those patients who are requiring a lot of respiratory support. They just don’t have the resources, the staffing to check on them as frequently as they feel that they would want to. And perhaps that’s their comfort level as well.” Consultant Physician
Institutional Policies “We had one patient who had an Ivor Lewis (operation) who went out to the floor. He had some delirium in the ICU and just wasn’t quite over it yet. (While) on the floor, (he) pulled out his NG tube, and needed to have the Cortrak® type of NG tube, and so he came back to the ICU just for an NG tube placement.” Nurse “A lot of times we’ll get requests to admit a patient for a procedure, like a central line or a paracentesis or a thoracentesis.” Resident Physician