Other Titles
Beyond the Patient Flow Centre: What Drives ICU Discharge? [Title Slide]
Abstract
Background: Discharge delay in resource-constrained Intensive Care Units (ICUs) remains a concerning and persistent challenge, resulting in delayed ICU admissions and after-hours discharges. These delays are associated with adverse patient outcomes and system inefficiency. While centralised patient flow centres and other strategies have been implemented to address these issues, their impact on ICU discharge delays remains unexplored. To improve patient flow, it is essential to explore organisational barriers and facilitators to ICU discharge.
Objective: To identify system factors influencing ICU discharge in a tertiary Australian hospital.
Methods: A mixed-method study was conducted in a 32-bed tertiary ICU in Australia. Between June and August 2024, structured observations of ICU discharge events were conducted using a discharge process report form. These observations captured key process indicators, including discharge criteria, discharge timing, and reasons for delayed discharges. To explore perceptions and experiences of the discharge process, semi-structured interviews were conducted with clinicians involved in ICU patient discharge, focusing on identifying barriers and facilitators to ICU discharge. Categorical variables were summarised as frequencies and percentages, while continuous variables were reported as medians and interquartile ranges where appropriate. Qualitative data were analysed using deductive and inductive content analysis, underpinned by the Theoretical Domains Framework.
Findings: A total of 22 ICU discharges were observed, and 27 staff interviews were conducted. All observed patients experienced an ICU discharge delay after being ready. The main reasons for ICU discharge delays were the unavailability of ward beds (46.4%), ward beds' unreadiness (35.7%) and limited isolation rooms (14.3%). Interviews highlighted key domains that influence the discharge process, including beliefs and consequences, environmental context and resources, and social influences. Both ICU discharge observations and staff interviews suggested that organisational factors, such as high hospital occupancy and limited ward capacity, were attributable to suboptimal patient flow.
Conclusions: This study highlights the multifaceted nature of ICU discharge delays, driven by both structural and behavioural factors. A targeted strategy, co-designed with clinicians and consumers, is essential to optimise ICU patient flow, improve patient experience and enhance efficiency.
Notes
References:
1. Forster, G., Bihari, S., Tiruvoipati, R., Bailey, M., & Pilcher, D. (2020). The Association between Discharge Delay from Intensive Care and Patient Outcomes. Am J Respir Crit Care Med, 202(10), 1399-1406. https://doi.org/10.1164/rccm.201912-2418OC.
2. Tiruvoipati, R., Botha, J., Fletcher, J., Gangopadhyay, H., Majumdar, M., Vij, S., Paul, E., & Pilcher, D. (2017). Intensive care discharge delay is associated with increased hospital length of stay: A multicentre prospective observational study. PLoS One, 12(7), e0181827. https://doi.org/10.1371/journal.pone.0181827.
3. Ofoma, U. R., Montoya, J., Saha, D., Berger, A., Kirchner, H. L., McIlwaine, J. K., & Kethireddy, S. (2020). Associations between hospital occupancy, intensive care unit transfer delay and hospital mortality. Journal of Critical Care, 58, 48-55. https://doi.org/https://doi.org/10.1016/j.jcrc.2020.04.009
Sigma Membership
Non-member
Type
Presentation
Format Type
Text-based Document
Study Design/Type
Other
Research Approach
Mixed/Multi Method Research
Keywords:
Acute Care, Implementation Science, Intensive Care Patients, Discharge Planning, Tertiary Care, Australia
Recommended Citation
Jin, Xia; Adams, Anne Mette Nørby; McIntyre, JoAnne; Galluccio, Steven; Bihari, Shailesh; Wiersema, Ubbo F.; De Lyster, Kathrine; and Lin, Frances Fengzhi, "Unpacking System Factors Contributing to Delayed ICU Discharges: A Mixed-Method Study" (2026). International Nursing Research Congress (INRC). 169.
https://www.sigmarepository.org/inrc/2026/presentations_2026/169
Conference Name
37th International Nursing Research Congress
Conference Host
Sigma Theta Tau International
Conference Location
Toronto, Ontario, Canada
Conference Year
2026
Rights Holder
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record. All permission requests should be directed accordingly and not to the Sigma Repository. All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.
Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
Date of Issue
2026-08-13
Unpacking System Factors Contributing to Delayed ICU Discharges: A Mixed-Method Study
Toronto, Ontario, Canada
Background: Discharge delay in resource-constrained Intensive Care Units (ICUs) remains a concerning and persistent challenge, resulting in delayed ICU admissions and after-hours discharges. These delays are associated with adverse patient outcomes and system inefficiency. While centralised patient flow centres and other strategies have been implemented to address these issues, their impact on ICU discharge delays remains unexplored. To improve patient flow, it is essential to explore organisational barriers and facilitators to ICU discharge.
Objective: To identify system factors influencing ICU discharge in a tertiary Australian hospital.
Methods: A mixed-method study was conducted in a 32-bed tertiary ICU in Australia. Between June and August 2024, structured observations of ICU discharge events were conducted using a discharge process report form. These observations captured key process indicators, including discharge criteria, discharge timing, and reasons for delayed discharges. To explore perceptions and experiences of the discharge process, semi-structured interviews were conducted with clinicians involved in ICU patient discharge, focusing on identifying barriers and facilitators to ICU discharge. Categorical variables were summarised as frequencies and percentages, while continuous variables were reported as medians and interquartile ranges where appropriate. Qualitative data were analysed using deductive and inductive content analysis, underpinned by the Theoretical Domains Framework.
Findings: A total of 22 ICU discharges were observed, and 27 staff interviews were conducted. All observed patients experienced an ICU discharge delay after being ready. The main reasons for ICU discharge delays were the unavailability of ward beds (46.4%), ward beds' unreadiness (35.7%) and limited isolation rooms (14.3%). Interviews highlighted key domains that influence the discharge process, including beliefs and consequences, environmental context and resources, and social influences. Both ICU discharge observations and staff interviews suggested that organisational factors, such as high hospital occupancy and limited ward capacity, were attributable to suboptimal patient flow.
Conclusions: This study highlights the multifaceted nature of ICU discharge delays, driven by both structural and behavioural factors. A targeted strategy, co-designed with clinicians and consumers, is essential to optimise ICU patient flow, improve patient experience and enhance efficiency.
Description
This mixed-methods study examined barriers and facilitators to ICU discharge through direct observations and semi-structured interviews. All observed patients experienced discharge delay after being ready for transfer due to the unavailability of ward beds and limited isolation rooms. Interviews with 25 staff identified key themes, including resource constraints and communication gaps. Findings from this study will inform the co-design of a targeted intervention to optimise ICU patient flow.