Author(s): Kingston E.
Source: Anaesthesia; Jul 2018; vol. 73 ; p. 104
Publication Date: Jul 2018
Publication Type(s): Conference Abstract
Abstract:Delayed discharge causes unnecessary exposure to critical care, risk of cross infection, and risk of late night discharges (associated with poorer clinical handover and patient outcomes) . Patient discharges from critical care between 22.00-06.59 should be recorded as adverse events . This audit examined timeliness of discharge for overdose patients on critical care. Methods A retrospective study of ICNARC database for patients admitted to/discharged from University Hospital Aintree Intensive Care Unit (ICU) with a diagnosis of self-harm by intentional overdose (December 2014-June 2016) was carried out. Aims 100% of overdose patients discharged from ICU within 4 h of being declared medically fit  100% of overdose patients discharged from ICU within routine hours (07.00-21.59) Results In total, 91 of 109 ICNARC cases were analysed (excluded: 13 accidental overdoses, 2 incorrect coding, 3 deaths). In total, 5.5% (5/91) patients were discharged out of hours. There was an average of 2-4 days between referral and review by the Mental Health Liaison team (MHLT). Significant delays were seen in patients referred at the weekend, waiting for psychiatric review or an interim ward bed. Average interval between admission and fitness to discharge varied according to ventilation status: 0.84 days (non-ventilated) vs. 3.36 days (ventilated). Average interval between extubation and fitness for discharge from ITU was 1.06 days. Discussion These data suggest that non-ventilated patients should be referred to the MHLT on the day of admission with an expectation of discharge within 24 h of admission, and ventilated patients should be referred 12 h post extubation with an expectation of fitness for discharge within 24 h. Common reasons identified for the failure to meet the audit standards were: i) Lack of availability of MHLT to review patients, ii) Patients not medically fit enough for transfer to psychiatry bed, iii) Insufficient interim ward beds and iv) Lack of available psychiatric beds Overdose patients are a significant proportion of avoidable critical care discharge delays, impacting achievement of the CQUIN TR1 target. These study data support calls for additional MHLT staff resourcing and use of an electronic referral system to improve data capture, and streamline the referral process.