We designed and pilot tested the PODS-ICU, a patient- and family-caregiver- focused written discharge summary tool to provide critically ill patients and their family-caregivers with key information on the patient’s stay in ICU, transition (i.e., discharge) from the ICU, and what to expect post-ICU. Our pilot study showed that the PODS-ICU was well accepted and participants viewed their discharge from the ICU positively when it was used. However, the pilot study also showed that while the tool had high acceptability, it was not feasible to administer in the ICU settings as: 1) the time to discharge varies for each patient and current clinical practices did not allow for the tool to be consistently delivered, and 2) clinicians found the PODS-ICU to be time consuming and fit poorly within their clinical workflow.
The practice of providing written information to patients and/or their family-caregivers at the point of discharge from the ICU remains uncommon,36 with very few existing tools to aid in that process.31 Previous evaluations of written discharge communications for patients and family-caregivers have shown that these tools can improve family-caregiver satisfaction with care in the ICU,37 decrease family-caregiver ‘transfer’ anxiety around transitions from the ICU,38,39 help patients and families understand and accept ICU events,40,41 help ‘fill in the gaps’ for patients with memory lapses,42,43 and improve longer term patient outcomes.44 In developing the PODS-ICU tool, we relied on the pre-existing OpenLab PODS tool21,27,45 and input from patient-partners to ensure the tool addressed specific informational needs of patients in the ICU (e.g., summary of ICU events, medications, upcoming tests and appointments, what to expect during recovery, resources for help). This allowed the PODS-ICU to support reliable delivery of essential information from clinicians to patients and family-caregivers at discharge from the ICU, whether the patient was being transferred to a ward in the hospital or directly home. In our study, clinicians reported the PODS-ICU tool to generate comprehensive and beneficial summaries. Interestingly, previous evaluations of summary tools have reported similar challenges to those we observed in implementing the PODS-ICU, such as varying clinician motivation to complete the tool due to lack of time, competing priorities, and/or negative perceptions of the tool’s utility.40 Due to these limitations, clinicians in our study struggled with the feasibility of incorporating this tool into their workflow.
Pilot implementation of the PODS-ICU highlights important opportunities to improve clinician-patient communication during a discharge from the ICU. These include: 1) earlier discharge planning (i.e., preparation for discharge begins as soon as a patient is admitted), 2) integration of discharge communication with electronic clinical information systems, and 3) regular incorporation of teach-back into clinician-patient communications. At a practical level, earlier discharge planning could prompt clinicians to begin completing parts of the discharge summary as soon as a patient is admitted, perhaps fitting better into their workflow. Electronic clinical information systems provide the potential to partially automate the population of patient data into discharge summaries, a time-consuming aspect of the PODS-ICU. Pre-population of discharge summaries with patient data can increase efficiency and potentially reduce the risk of human transcription error.46,47 Finally, incorporating the teach-back method into clinician-patient and clinician-family-caregiver communications, an important aspect of the PODS-ICU and recommended by the Agency for Healthcare Research and Quality (AHRQ),48 has been shown to improve patients’ understanding of their health information.49 This could foster better connections between patients and clinicians,34 further benefitting communication efforts.
There are a number of limitations to consider when interpreting the results of our pilot study. First, only a small number of participants (n=9 patients and n=6 family-caregivers) received the PODS-ICU tool. Although we were able to ascertain some reasons for the low delivery of PODS-ICU (i.e., availability of research team nurses and time required to complete the tool), an assessment by more patients, family-caregivers and clinicians could provide more insights into the usability of the tool. Second, we pilot tested the PODS-ICU in two study ICUs in a single city (Calgary) in Canada. We recognize that ICU populations differ in type and severity of illness and some ICU staff may have more capacity to implement the PODS-ICU. As the OpenLab’s PODS has shown the potential to improve patient outcomes in various care settings,21,45 the PODS-ICU may be more successful in settings where it is better integrated into clinician work flow. 45