Quality statement 3: Information on discharge from hospital

Quality statement

Adults who were in critical care and at risk of morbidity are given information based on their rehabilitation goals before they are discharged from hospital.

Rationale

Discussions about what to expect after discharge should be happening as adults who were in critical care and at risk of morbidity continue to recover in hospital. Moving from hospital to a home environment can be difficult and cause a lot of anxiety. It is important to make information relevant to the person and their situation. They should know how to continue working towards the goals they set out while in hospital and who to contact if they need any support. This information should be given to the person and to family members or carers if the person agrees.

Quality measures

Structure

Evidence of local arrangements to provide adults who are discharged from hospital after a critical care stay with information relevant to their individual needs and rehabilitation goals.

Data source: Local data collection, for example, hospital discharge protocols.

Process

Proportion of adults who were in critical care and at risk of morbidity who are given information on hospital discharge based on the rehabilitation goals agreed during their hospital stay.

Numerator – the number in the denominator who are given information based on the rehabilitation goals agreed during their hospital stay.

Denominator – the number of adults who were in critical care and at risk of morbidity discharged from hospital.

Data source: Local data collection, for example, an audit of patient hospital records.

Outcome

Levels of satisfaction with information that was relevant to recovery at home among adults who were discharged from hospital following a critical care stay.

Data source: Local data collection, for example, a patient and carer satisfaction survey.

What the quality statement means for different audiences

Service providers (hospitals) have protocols in place to ensure that adults who were in critical care and at risk of morbidity are given information about what to expect after discharge from hospital. The information is based on the rehabilitation goals agreed during the hospital stay. If the person agrees, this information can also be given to their family or carer.

Healthcare professionals (members of the team responsible for discharge) give adults who were in critical care and at risk of morbidity information about what to expect after discharge from hospital. The information is based on the rehabilitation goals agreed during the hospital stay. If the person agrees, this information can also be given to their family or carer.

Commissioners (clinical commissioning groups) ensure that the services they commission have arrangements in place to give adults who were in critical care and at risk of morbidity information about what to expect after discharge from hospital. The information is based on the rehabilitation goals agreed during the hospital stay. If the person agrees, this information can also be given to their family or carer.

Adults who were in critical care and at risk of long-term health problems are given information about what to expect when they leave hospital. This should explain what they can do to help their recovery and what other things they might face during this period. If they agree, this information can also be given to their family or carer.

Source guidance

Rehabilitation after critical illness in adults (2009) NICE guideline CG83, recommendation 1.22

Definitions of terms used in this quality statement

Adults in critical care at risk of morbidity

People's risk of morbidity should be identified in a short clinical assessment that includes physical and non-physical elements. Examples include:

  • Physical

    • Anticipated long duration of critical care stay.

    • Obvious significant physical or neurological injury.

    • Unable to self-ventilate on 35% oxygen or less.

    • Presence of premorbid respiratory or mobility problems.

    • Risk or presence of malnutrition, changes in eating patterns, poor or excessive appetite, inability to eat or drink.

    • Unable to get in and out of bed independently.

    • Unable to mobilise independently over short distances.

  • Non-physical

    • Recurrent nightmares, particularly where patients report trying to stay awake to avoid nightmares.

    • Intrusive memories of traumatic events that have occurred before admission (for example, road traffic accidents) or during their critical care stay (for example, delusion experiences or flashbacks).

    • Acute stress reactions including symptoms of new and recurrent anxiety, panic attacks, fear, low mood, anger or irritability in the critical care unit.

    • Hallucinations, delusions and excessive worry or suspiciousness.

    • Expressing the wish not to talk about their illness or changing the subject quickly to another topic.

    • Lack of cognitive functioning to continue to exercise independently.

[Adapted from NICE's guideline on rehabilitation after critical illness in adults, recommendation 1.2, table 1 and expert opinion]

Information

The following information should be given before discharge:

  • Information about physical and cognitive recovery and rate of recovery, based on the rehabilitation goals set during ward-based care, if applicable.

  • Information about psychological and emotional recovery, including symptoms that frequently occur in the months after critical illness (for example, low mood, anxiety, flashbacks and nightmares, changes or conflict in relationships).

  • If applicable, information about diet and any other continuing treatments.

  • Information about how to manage activities of daily living, including self-care and re-engaging with everyday life.

  • If applicable, information about driving, returning to work, housing and benefits.

  • Information about local statutory and non-statutory support services, such as support groups.

  • General guidance, especially for the family or carers, on what to expect and how to support the person at home. This should take into account both the person's needs and the family's or carers' needs.

The person should be given their own copy of the critical care discharge summary.

[Adapted from NICE's guideline on rehabilitation after critical illness in adults, recommendation 1.22 and expert opinion]

Equality and diversity considerations

People who do not speak or read English well may be at a disadvantage, particularly because of the complex language used in critical care. Translators should be available if needed to ensure that people understand the information given to them. Arrangements should be made to account for the extra time that this may require.