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01.12.2017 | Research article | Ausgabe 1/2017 Open Access

BMC Health Services Research 1/2017

Barriers and facilitators to improve safety and efficiency of the ICU discharge process: a mixed methods study

BMC Health Services Research > Ausgabe 1/2017
Nelleke van Sluisveld, Anke Oerlemans, Gert Westert, Johannes Gerardus van der Hoeven, Hub Wollersheim, Marieke Zegers
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Electronic supplementary material

The online version of this article (doi:10.​1186/​s12913-017-2139-x) contains supplementary material, which is available to authorized users.



Evidence indicates that suboptimal clinical handover from the intensive care unit (ICU) to general wards leads to unnecessary ICU readmissions and increased mortality. We aimed to gain insight into barriers and facilitators to implement and use ICU discharge practices.


A mixed methods approach was conducted, using 1) 23 individual and four focus group interviews, with post-ICU patients, ICU managers, and nurses and physicians working in the ICU or general ward of ten Dutch hospitals, and 2) a questionnaire survey, which contained 27 statements derived from the interviews, and was completed by 166 ICU physicians (21.8%) from 64 Dutch hospitals (71.1% of the total of 90 Dutch hospitals).


The interviews resulted in 66 barriers and facilitators related to: the intervention (e.g., feasibility); the professional (e.g., attitude towards checklists); social factors (e.g., presence or absence of a culture of feedback); and the organisation (e.g., financial resources). A facilitator considered important by ICU physicians was a checklist to structure discharge communication (92.2%). Barriers deemed important were lack of a culture of feedback (55.4%), an absence of discharge criteria (23.5%), and an overestimation of the capabilities of general wards to care for complex patients by ICU physicians (74.7%).


Based on the barriers and facilitators found in this study, improving handover communication, formulating specific discharge criteria, stimulating a culture of feedback, and preventing overestimation of the general ward are important to effectively improve the ICU discharge process.
Additional file 1: Consolidated criteria for reporting qualitative studies (COREQ). (PDF 609 kb)
Additional file 2: Example of the individual interview guide. (PDF 424 kb)
Additional file 3: Example of the focus group interview guide. (PDF 275 kb)
Additional file 4: Subgroup analyses. (PDF 468 kb)
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