Exit blocks in Australian intensive care units: a national survey of ICU staff's perspectives on facilitators and barriers to timely discharge.

BACKGROUND

Intensive care bed block has been a persistent problem worldwide. Current Australian evidence is mostly from single or small-scale multisite studies, and there is a lack of evidence on a bigger scale.

OBJECTIVES

To explore multidisciplinary ICU staff's perspectives on the facilitators and barriers to timely ICU patient discharge in Australia.

METHODS

A national cross-sectional online survey was distributed via professional organisations to ICU staff across Australia. The survey comprised 45 quantitative and eight qualitative items informed by systematic reviews and studies.

RESULTS

A total of 114 ICU staff completed the survey. Three-quarters (n = 77, 75%) reported the discharge process as 'extremely' or 'somewhat difficult', with the majority (n = 91, 80%) reporting ward bed unavailability as the primary cause of discharge delay. Respondents expressed that emergency departments and operating theatres were prioritised over ICUs during hospital bed allocation. Ward bed allocation was mostly communicated verbally (n = 44, 39%) or by phone (n = 71, 62%), with only 39% (n = 44) using digital methods. Facilitators included post-ICU ward follow-up assessment and management, ICU discharge liaison nurse coordination of patient transfer and assessment of ward staffing, skill-mix and bed readiness. Additional factors included early identification of dischargeable patients, the use of guidelines, and adherence to policies and checklists. Barriers included lack of ward-level clinical support, incompatibility of documentation platforms, staff shortages and discharge task inefficiencies. Few respondents reported existing strategies to address discharge delays in their hospitals.

CONCLUSIONS

Respondents highlighted the need for improved digital systems, permanent discharge liaison or co-ordination roles, and post-ICU clinical support services with dedicated funding and appropriate or 24/7 coverage to support timely ICU discharge.

IMPLICATIONS FOR CLINICAL PRACTICE: Findings highlight the need for organisational-level and workflow-focused strategies to reduce ICU exit block to support timely and safe patient discharge across Australian ICUs.