User Centered Critical Care Discharge Information
User centred critical care discharge information (UCCDIP); an exploration of feasibility and effectiveness
Why did we do the study?
Feedback from focus groups that we conducted with patients, relatives and health care staff highlighted that discharge to the ward can be a very distressing time. Patients suffer particular problems; they can be confused, have limited concentration and difficulty in remembering information. Based on this feedback, we devised a new critical care discharge information pack called UCCDIP (standing for User Centred Critical Care Discharge Information). UCCDIP contains booklets where patients and their families can write down their questions and feelings. It also includes a 'patient discharge summary' written by the critical care nurse. The summary explains why the patient needed critical care, what happened to them and basic information such as how long they were in the unit.
What happened during the study?
To see what difference UCCDIP made, we recruited 158 patients and 80 relatives from a large hospital in London, England. Before they went to the ward, we gave patients and relatives UCCDIP, a booklet produced by the ICUsteps charity or verbal information only. We assessed their levels of anxiety, depression and perceptions of coping whilst on the ward. We also asked patients, relatives and nurses to complete a questionnaire describing their experiences.
What did we find?
We found no differences in anxiety, depression or coping between those given different types of information. However, patients who received verbal information alone worried much more than others about going to the ward. Sixty-seven (54%) patients reported having little or no understanding of what had happened to them in critical care. Patients, relatives and nurses reported that UCCDIP had the potential to help both the patient and the ward nurse understand what had happened in critical care, reduce relatives’ anxiety and enhance the ability to cope during this period. We also found that it was feasible for critical care nurses to complete the discharge summary in a busy department because for most of the nurses (71%), writing the summary had taken less than 15 minutes.
What does this mean?
Written information does not increase anxiety or depression and, in comparison to verbal information alone, reduces levels of worry during discharge from critical care to a ward. Findings suggest that, with further work on how and when it is provided, UCCDIP could make an important contribution to improving the discharge experience. In particular, the patient discharge summary may help patients understand their critical care experience, a vital first step towards recovery. Our findings also show that, as long as nurses have appropriate training and support, it is possible to deliver UCCDIP in a busy critical care environment.
If you would like further information, please email Suzanne Bench (UCCDIP project co-ordinator).