Indian Journal of Critical Care Medicine

Register      Login



Volume / Issue

Online First

Related articles

VOLUME 26 , ISSUE 5 ( May, 2022 ) > List of Articles

Original Article

Factors Influencing the Decision-making of Healthcare Providers Regarding the Transition of Patients from the Intensive Care Unit to the General Ward in Iran: A Qualitative Study

Kobra Ghorbanzadeh, Abbas Ebadi, Mohammadali Hosseini, Sadat Seyed Bagher Maddah, Hamidreza Khankeh, Maryam Khoshbakht Pishkhani, Vahid Adiban

Keywords : Decision-making, Intensive care unit, Patient, Transition

Citation Information : Ghorbanzadeh K, Ebadi A, Hosseini M, Maddah SS, Khankeh H, Pishkhani MK, Adiban V. Factors Influencing the Decision-making of Healthcare Providers Regarding the Transition of Patients from the Intensive Care Unit to the General Ward in Iran: A Qualitative Study. Indian J Crit Care Med 2022; 26 (5):568-573.

DOI: 10.5005/jp-journals-10071-24211

License: CC BY-NC 4.0

Published Online: 20-05-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Background: The process of making decisions to discharge patients from the intensive care unit (ICU) is very complex and risky, and decisions need to be made under time constraints and based on fair allocation of resources. In this situation, decision-making requires team participation, which is often accompanied by tension and conflict between team members and sometimes family members, which in turn affects patient safety and quality of care. Objectives: The aim of this study was to explore the experiences and perceptions of physicians and nurses regarding the decision-making process in transition of patients from the ICU to the general ward. Materials and methods: This qualitative study was conducted based on purposive sampling among six nurses and six physicians in Governmental teaching hospitals. The data collection process was conducted from July 2018 to January 2019 through a semistructured interview. Interviews were transcribed and data analysis was accomplished according to the steps proposed by Graneheim and Lundman (2004). Results: Data analysis revealed six themes that reflected factors influencing decision-making in transition of patients from the ICU to the general ward: contingent decision-making, risky decision-making, lack of coherence in team decision-making, differences in clinical judgment, legal and ethical responsibility, and lack of clear criteria. Conclusion: The process of decision-making regarding patient transfer from the ICU is a complex and stressful one. It is affected by situations, team participation, clinical judgment skill, legal issues, and multifactorial challenges. To improve decision-making processes, we need to develop abilities and knowledge and design proper interventions to achieve a principled and correct decision-making process.

  1. McNett M, McLaughlin D. Transitions of care for patients with neurologic diagnoses transition from the intensive care unit to the floor. Nurs Clin N Am 2019;54(3):347–355. DOI: 10.1016/j.cnur.2019.04.005.
  2. Josepha op‘t SAJ, Dautzenberg M, Eskes AM, Vermeulen H, Vloet LCM. The experiences and needs of relatives of intensive care unit patients during the transition from the intensive care unit to a general ward: a qualitative study. Aust Crit Care 2020;33(6):526–532. DOI: 10.1016/j.aucc.2020.01.004.
  3. de Grood C, McIntosh CJ, Boyd JM, Zjadewicz K, Leigh JP, Stelfox HT. Identifying essential elements to include in Intensive Care Unit to hospital ward transfer summaries: a consensus methodology. J Crit Care 2019;49:27–32. DOI: 10.1016/j.jcrc.2018.10.001.
  4. Li P, Boyd JM, Ghali WA, Stelfox HT. Stakeholder views regarding patient discharge from intensive care: suboptimal quality and opportunities for improvement. Can Respir J 2015;22(2):109–118. DOI: 10.1155/2015/457431.
  5. Stelfox HT, Lane D, Boyd JM, Taylor S, Perrier L, Straus S, et al. A scoping review of patient discharge from intensive care: opportunities and tools to improve care. Chest 2015;147(2):317–327. DOI: 10.1378/chest.13-2965.
  6. Graan SM, Botti M, Wood B, Redley B. Nursing handover from ICU to cardiac ward: standardised tools to reduce safety risks. Austr Crit Care 2016;29(3):165–171. DOI: 10.1016/j.aucc.2015.09.002.
  7. Hosein FS, Bobrovitz N, Berthelot S, Zygun D, Ghali WA, Stelfox HT. A systematic review of tools for predicting severe adverse events following patient discharge from intensive care units. Crit Care 2013;17(3):1. DOI: 10.1186/cc12747.
  8. Sanson G, Marino C, Valenti A, Lucangelo U, Berlot G. Is my patient ready for a safe transfer to a lower-intensity care setting? Nursing complexity as an independent predictor of adverse events risk after ICU discharge. Heart Lung 2020;49(4):407. DOI: 10.1016/j.hrtlng.2020.02.003.
  9. Taniguchi LU, Ramos FJdS, Momma AK, Martins Filho APR, Bartocci JJ, Lopes MFD, et al. Subjective score and outcomes after discharge from the intensive care unit: a prospective observational study. J Int Med Res 2019;47(9):4183–4193. DOI: 10.1177/0300060519859736.
  10. van Sluisveld N, Hesselink G, van der Hoeven JG, Westert G, Wollersheim H, Zegers M. Improving clinical handover between intensive care unit and general ward professionals at intensive care unit discharge. Intensive Care Med 2015;41(4):589–604. DOI: 10.1007/s00134-015-3666-8.
  11. Cline DD. A concept analysis of vulnerability during transitions. Nurs Educ Perspect 2016;37(2):91–96. PMID: 27209867.
  12. Cullati S, Hudelson P, Ricou B, Nendaz M, Perneger TV, Escher M. Internists’ and intensivists’ roles in intensive care admission decisions: a qualitative study. BMC Health Serv Res 2018;18(1):620. DOI: 10.1186/s12913-018-3438-6.
  13. Nates JL, Nunnally M, Kleinpell R, Blosser S, Goldner J, Birriel B, et al. ICU admission, discharge, and triage guidelines: a framework to enhance clinical operations, development of institutional policies, and further research. Crit Care Med 2016;44(8):1553–1602. DOI: 10.1097/CCM.0000000000001856.
  14. Graneheim UH, Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today 2004;24(2):105–112. DOI: 10.1016/j.nedt.2003.10.001.
  15. Lincoln YS, Lynham SA, Guba EG. Paradigmatic controversies, contradictions, and emerging confluences, revisited. In: The Sage handbook of qualitative research. 4th ed. 2011. p. 97–128.
  16. Boyd JM, Roberts DJ, Leigh JP, Stelfox HT. Administrator perspectives on ICU-to-ward transfers and content contained in existing transfer tools: a cross-sectional survey. J Gen Intern Med 2018;33(10): 1738–1745. DOI: 10.1007/s11606-018-4590-8.
  17. Tiruvoipati R, Botha J, Fletcher J, Gangopadhyay H, Majumdar M, Vij S, et al. Intensive care discharge delay is associated with increased hospital length of stay: a multicentre prospective observational study. PLoS One 2017;12(7):e0181827. DOI: 10.1371/journal.pone.0181827.
  18. van Sluisveld N, Oerlemans A, Westert G, van der Hoeven JG, Wollersheim H, Zegers M. Barriers and facilitators to improve safety and efficiency of the ICU discharge process: a mixed methods study. BMC Health Serv Res 2017;17(1):251. DOI: 10.1186/s12913-017-2139-x.
  19. Ghorbanzadeh K, Ebadi A, Hosseini M, Madah SSB, Khankeh H. Challenges of the patient transition process from the intensive care unit: a qualitative study. Acute Crit Care 2021;36(2):133. DOI: 10.4266/acc.2020.00626.
  20. Garland A, Connors AF. Optimal timing of transfer out of the intensive care unit. Am J Crit Care 2013;22(5):390–397. DOI: 10.4037/ajcc2013973.
  21. Häggström M, Fjellner C, Öhman M, Holmström MR. Ward visits-one essential step in intensive care follow-up. An interview study with critical care nurses’ and ward nurses’. Intensive Crit Care Nurs 2018;49:21–27. DOI: 10.1016/j.iccn.2018.08.011.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.