Table 1 Final list of consented ICU discharge criteria
Final list of ICU discharge criteria | Fit for ICU discharge | Needs further intensive care therapy / monitoring | Value calculation method to evaluate discharge readiness | Criterion importance rank | Exceptions when "mandatory to be met" | |
|---|---|---|---|---|---|---|
Respiratory system | ||||||
1 | Is the patient's (own / artificial) airway patent? | yes | no | n.a | mandatory to be met | EOL-care, agreed treatment limits |
2 | Is the cough effective in a way, that the patient can be handled at the receiving unit? | yes | no | n.a | mandatory to be met | EOL-care, agreed treatment limits, p. with low level of consciousness and requiring long-term artificial airway aspiration |
3 | Blood oxygenation: Stable SpO2 (≥ 92% OR stable around lower patient individual baseline value) AND patient is breathing on room air? | yes | no | Worst value must be above threshold value AND trend must be stable over defined time frame | mandatory to be met | EOL-care, agreed treatment limits, p. with chronic lung disease |
4 | Respiratory rate: Stable RR trend with 10 ≤ resp ≤ 30 (pm) OR patient's individual baseline value is met? | yes | no | Worst value must be within acceptable range AND trend must be stable over defined time frame | mandatory to be met | EOL-care |
5 | If further respiratory support is needed, feasible at the receiving unit? | yes | no | n.a | mandatory to be met | |
6 | If the patient is in need of tracheal suctioning, feasible at the receiving unit? | yes | no | n.a | mandatory to be met | |
7 | If the patient is in need of long-term tracheostomy, could adequate care be provided at the receiving unit? | yes | no | n.a | mandatory to be met | If patient is sufficiently trained and capable to take care of the tracheostomy |
Cardiovascular system | ||||||
8 | Heart rate: Stable HR trend with 50 ≤ hr ≤ 110 (bpm) OR patient's individual baseline value is met? | yes | no | Worst value must be within acceptable range AND trend must be stable over defined time frame | mandatory to be met | EOL-care, agreed treatment limits, pre-existing bradycardia |
9 | Cardiac rhythm: Stable cardiac rhythm OR tolerable intermittent arrhythmia over defined time frame? | yes | no | Trend must be stable over defined time frame | mandatory to be met | EOL-care, agreed treatment limits, p. has intermittent AF but is otherwise hemodynamically stable with controlled ventricular response |
10 | Mean arterial pressure: Stable MAP trend with 60 < map ≤ 110 (mmHg) OR patient's individual baseline value is met? | yes | no | Worst value must be within acceptable range AND trend must be stable over defined time frame | mandatory to be met | EOL-care, agreed treatment limits |
11 | Hypervolemia / hypovolemia: Does the current volemia status require ICU monitoring? | no | yes | n.a | mandatory to be met | |
12 | Hemoglobin value stable over defined time frame? | yes | no | Trend must be stable over defined time frame | mandatory to be met | EOL-care, agreed treatment limits |
13 | Significant active bleeding or high risk of significant bleeding? | no | yes | n.a | mandatory to be met | EOL-care, agreed treatment limits |
14 | If the patient needs continued monitoring at the receiving unit, are required technology / staff capabilities in place? | yes | no | n.a | mandatory to be met | |
15 | If the patient carries a percutaneous transient pacemaker, could that be handled at the receiving unit? | yes | no | n.a | mandatory to be met | |
16 | If low-dose vasoactives are in use, is the patient manageable at the receiving unit? | yes | no | n.a | mandatory to be met | |
Central nervous system | ||||||
17 | Can the neurological status of the patient be adequately handled and monitored at the receiving unit? | yes | no | n.a | mandatory to be met | |
Pain | ||||||
18 | Pain therapy sufficient and feasible at the receiving unit? | yes | no | n.a | mandatory to be met | |
Urogenital system | ||||||
19 | Do urine output, electrolyte level, and renal function allow patient discharge? | yes | no | n.a | mandatory to be met | EOL-care, agreed treatment limits |
20 | If required, renal replacement therapy possible outside the ICU? | yes | no | n.a | mandatory to be met | EOL-care, agreed treatment limits |
Fluid loss and drainages | ||||||
21 | Could fluid loss or drainage(s) be monitored and handled adequately at the receiving unit? | yes | no | n.a | mandatory to be met | |
Medication and nutrition | ||||||
22 | If the patient needs continuous IV application (e.g. Insulin, glucose, antibiotics, vasopressors, nutrition), allowed and feasible at the receiving unit? | yes | no | n.a | mandatory to be met | |
Patient diagnosis, prognosis and preferences | ||||||
23 | Patient's preference is to stop intensive care therapy and to leave the ICU | yes | no | n.a | not mandatory to be met | |
24 | Therapeutic susceptibility: Patient doesn't benefit from ICU care anymore and negative effects may outweigh | yes | no | n.a | mandatory to be met | |
Institution specific criteria | ||||||
25 | Patient no longer meets ICU admission criteria and meets admission criteria for a lower level of care | yes | no | n.a | mandatory to be met | |
26 | Do current acuity and dependency levels and current workload at the receiving unit allow to admit and take care of this patient? | yes | no | n.a | mandatory to be met | |
27 | If the patient is immune-compromised or infectious, could the patient be handled and adequately cared for at the receiving unit? | yes | no | n.a | mandatory to be met | |
28 | If discharge at night or weekend can't be avoided, are measures in place to protect patient safety? | yes | no | n.a | mandatory to be met | EOL-care, agreed treatment limits, priotarisation against patients with greater need for intensive care |