The Construction And Evaluation Of ICU Transitional Care Programme

Objectives:At present,most of the domestic studies about ICU transition nursing lack standardized and unified ICU transitional care procedures and programs.The purpose of this study is to establish a set of transitional care programme for patients transfer out of ICU,and evaluate the effect of the programme through a quasi-experimental study,in order to provide scientific,standard,continuous nursing intervention,promote the nursing safety of ICU patients transferred out transition,reduce the ICU return rate and the incidence of adverse events.Methods:A mixed methods design was used.Firstly,a qualitative study was employed to explore the specific content of ICU transitional care;Secondly,the ICU transitional care programme was constructed by Delphi method;Finally,a quasi-experimental trial was conducted to verify the effectiveness of the ICU transitional care programme.1.Literature analysis.Read and screen relevant literature for analysis,extract relevant content of ICU transitional care,and summarize the conceptual framework of this study.2.Qualitative research on the nursing practice of ICU transitional care.From August 2017 to February 2018,we selected 24 participants from a general hospital in Shanghai to take semi-structured interviews.We used content analysis method to analyze the interview data,and got four themes of ICU transitional care practice,22 secondary indexes,48 tertiary indicators.3.The construction of ICU transitional care programme.According to the results of the above qualitative study,the preliminary plan of ICU transitional care was established.25 experts in related fields were selected to screen and modify the specific items of the program through,and finally the transitional care program of ICU was formed.4.Verification of the programme.In this study,a comprehensive ICU of a general hospital in Shanghai was selected as the institution to evaluate the programme.Convenient sampling method was adopted to select the transferred ICU patients from August to October 2018 as the control group,and the transferred ICU patients from November 2018 to January 2019 as the experimental group to use the transitional care scheme of ICU.To evaluate the differences between the two groups in ICU return rate,ICU length of stay,total length of stay,incidence of adverse events and level of anxiety and depression.Results:1.Results of qualitative research.The four themes of the ICU transitional care programme are preoperative visit before ICU admission,evaluation and coordination before ICU transfer,in-hospital transfer from ICU to general ward,and planned follow-up after ICU transfer.2.The development of the programme.The ICU transitional care programme covering two processes of patient transfer to ICU and transfer out from ICU and four time nodes was constructed,including 7 primary indicators,22 secondary indicators and 48 tertiary indicators.3.The implication and the evaluation of the programme.The ICU reentry rate of the experimental group patients was lower than that of the control group patients,and the difference was statistically significant(P < 0.05).The length of ICU stay in the experimental group patients was lower than that in the control group patients,and the difference was not statistically significant(P > 0.05).The total length of hospital stay in the experimental group patients was lower than that in the control group patients,and the difference was statistically significant(P < 0.05).The incidence of adverse events in the experimental group patients was lower than that in the control group patients,and the difference was not statistically significant(P > 0.05).The level of anxiety and depression in the experimental group patients was significantly different from that in the control group patients(P < 0.05).Conclusions:1.The implementation of ICU transitional care programme can reduce the return rate of ICU for patients transferred out of ICU;2.The implementation of ICU transitional care programme can shorten the total hospitalization time of patients;3.The implementation of ICU transitional care programme can reduce the depression level of patients during the transition period;4.The implementation of ICU transitional care programme failed to show significant differences in shortening ICU hospitalization time,reducing the incidence of adverse events and anxiety level.