Table 4 “Care provider” factors and illustrative quotes
Discharge decision-making | “Being more cautious in sending our (ICU) patients out (will affect readmissions). We do send patients out quickly. We look at (the patients) and say we’re not doing anything ICU-wise for them and then we’re done. Whereas we may not be giving them a lot of interventions that are ICU-related, they still may warrant some monitoring for longer.” Nurse “I think that in general it’s difficult to get patients out of the ICU. (During) rounds, as long as everybody seems to agree from a physician standpoint, it takes a lot for the nurse to be able to convince (the physician) to keep the patient (in the ICU), depending on who is on staff and who (else is on) the team.” Nurse |
Provider experience and comfort level | “Sometimes the nurses on the floor become uncomfortable with the patients who are per se ‘busy’, whether it’s adjusting to changes or agitation, so they call the emergency response team on these patients and (request) a higher level of care. Sometimes the (emergency response) calls are so repetitive that I think (the patients) just get accepted (into the ICU) because we always go down and assess them.” Nurse “(The readmissions) are overwhelmingly usually respiratory related, and the most prominent (cause) anecdotally would be nursing’s discomfort with respiratory issues, triggering the emergency response team as soon as they come to the floor, and they end up right back in the ICU.” Consultant Physician “Sometimes we have patients that, any time you get them up to the chair or something, their heart rate goes up to the 120 s or 130 s. That’s how they are. In the ICU, we feel comfortable with it because we see it all the time, and we can monitor very closely. On the floor, however, if a floor nurse sees that, they would be calling the emergency response team who then sends the patient back up to us.” Nurse |