Transição do cuidado na alta da Unidade de Terapia Intensiva: revisão de escopo

Hervé, Michele Elisa Weschenfelder; Zucatti, Paula Buchs; Lima, Maria Alice Dias Da Silva

Acessibilidade / Reportar erro

Brasil

Revista Latino-Americana de Enfermagem

Español English

Brasil

Español English

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Sumário

Artigo de Revisão • Rev. Latino-Am. Enfermagem 28 • 2020 • https://doi.org/10.1590/1518-8345.4008.3325 copiar

Transição do cuidado na alta da Unidade de Terapia Intensiva: revisão de escopo^* * Artigo extraído da dissertação de mestrado “Associação da Transição do Cuidado com Eventos Adversos após a Alta de um Centro de Terapia Intensiva”, apresentada à Universidade Federal do Rio Grande do Sul, Porto Alegre, RS. Apoio financeiro do Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Brasil, processo nº 4339972018-4.

Autoria SCIMAGO INSTITUTIONS RANKINGS

Objetivo:

mapear as evidências disponíveis sobre os componentes da transição do cuidado, as práticas, estratégias e ferramentas utilizadas na alta da Unidade de Terapia Intensiva para a Unidade de Internação e seu impacto nos desfechos de pacientes adultos.

Método:

revisão de escopo mediante estratégias de busca em seis bases de dados relevantes na área da saúde.

Resultados:

foram incluídos 37 artigos, nos quais foram identificadas 30 práticas, estratégias ou ferramentas para organização e execução do processo de transferência, com impactos positivos ou negativos, relacionadas a fatores intrínsecos à Unidade de Terapia Intensiva, à Unidade de Internação e transversais às equipes envolvidas. A análise dos desfechos ‘readmissão’ e ‘mortalidade’ foi prevalente nos estudos incluídos, nos quais se encontram tendências e potenciais ações protetoras para uma transição do cuidado bem-sucedida, contudo, ainda carecem de evidências mais robustas e consenso na literatura.

Conclusão:

foram identificados componentes e práticas de transição do cuidado, além de fatores intrínsecos ao paciente, associados a piores desfechos após a alta da Unidade de Terapia Intensiva. A alta noturna ou em finais-de-semana mostrou associação com aumento nas taxas de readmissão e mortalidade, porém, a associação das demais práticas com o desfecho do paciente ainda é inconclusiva.

Descritores:
Cuidados Críticos; Unidades de Terapia Intensiva; Transferência de Pacientes; Continuidade da Assistência ao Paciente; Alta do Paciente; Transferência da Responsabilidade pelo Paciente

Base	Estratégia	Limitadores
PubMed	Search (“Intensive Care Units”[Mesh] OR “critical care”[tw] OR “intensive care”[tw]) AND (“Continuity of Patient Care”[Mesh] OR “Continuity of Patient Care”[tw] OR (“Patient Discharge”[tw] AND “patient readmission”[tw]) OR “discharge practice”[tw] OR “discharge planning”[tw] OR “Patient Handoff”[tw] OR “Patient Transfer”[tw] OR “Patient Handover”[tw] OR (“patient care team”[tw] AND “communicat”[tw]) OR “care transition”[tw]) AND (adult[tw] OR “Adult”[Mesh] OR aged[tw])	Journal Article; published in the last 5 years; Humans; English; Portuguese; Spanish
CINAHL	TX ((“Intensive Care Units” OR “critical care” OR “intensive care”) AND (“Continuity of Patient Care” OR (“Patient Discharge” AND “patient readmission”) OR “discharge practice” OR “discharge planning” OR “Patient Handoff” OR “Patient Transfer” OR “Patient Handover” OR (“patient care team” AND “communicat”) OR “care transition”)) AND AG (adult OR aged)	Data de publicação: 20130101-20181231; Idioma: English, Portuguese, Spanish
LILACS	(“Intensive Care Units” OR “critical care” OR “intensive care”) AND (“Continuity of Patient Care” OR (“Patient Discharge” AND “patient readmission”) OR “discharge practice” OR “discharge planning” OR “Patient Handoff” OR “Patient Transfer” OR “Patient Handover” OR (“patient care team” AND “communicat”) OR “care transition*”) [Palavras]	2013 OR 2014 OR 2015 OR 2016 OR 2017 OR 2018 [País, ano de publicação]
Web of Science	Tópico: ((“Intensive Care Units” OR “critical care” OR “intensive care”) AND (“Continuity of Patient Care” OR (“Patient Discharge” AND “patient readmission”) OR “discharge practice” OR “discharge planning” OR “Patient Handoff” OR “Patient Transfer” OR “Patient Handover” OR (“patient care team” AND “communicat”) OR “care transition”) AND (adult OR aged))	Anos da publicação: (2018 OR 2017 OR 2016 OR 2015 OR 2014 OR 2013) AND Idiomas: (ENGLISH OR PORTUGUESE OR SPANISH)
Scopus	TITLE-ABS-KEY (“Intensive Care Units” OR “critical care” OR “intensive care”) AND TITLE-ABS-KEY (“Continuity of Patient Care” OR (“Patient Discharge” AND “patient readmission”) OR “discharge practice” OR “discharge planning” OR “Patient Handoff” OR “Patient Transfer” OR “Patient Handover” OR (“patient care team” AND “communicat”) OR “care transition”) AND TITLE-ABS-KEY (adult OR aged)	(LIMIT-TO (PUBYEAR, 2018) OR LIMIT-TO (PUBYEAR, 2017) OR LIMIT-TO (PUBYEAR, 2016) OR LIMIT-TO (PUBYEAR, 2015) OR LIMIT-TO (PUBYEAR, 2014) OR LIMIT-TO (PUBYEAR, 2013)) AND (LIMIT-TO (LANGUAGE, “English”) OR LIMIT-TO (LANGUAGE, “Spanish”) OR LIMIT-TO (LANGUAGE, “Portuguese”))
Embase	Al fields (‘intensive care’ OR ‘intensive care unit’) AND (‘patient transfer’ OR (‘patient care’ AND ‘interpersonal communication’) OR ‘clinical handover’ OR ‘care transition’) AND ([adult]/lim OR [aged]/lim OR [middle aged]/lim OR [very elderly]/lim OR [young adult]/lim)	(2013:py OR 2014:py OR 2015:py OR 2016:py OR 2017:py OR 2018:py) AND ([english]/lim OR [portuguese]/lim OR [spanish]/lim)

Características	n^* * N = Número de artigos;	%^† † Porcentagem de artigos
País
Estados Unidos	8	21,6
Canadá	6	16,2
Austrália	4	10,8
Austrália/Nova Zelândia	3	8,1
Suécia	3	8,1
Reino Unido	3	8,1
Holanda	2	5,4
Coréia do Sul	2	5,4
Brasil	1	2,7
Argentina	1	2,7
Uruguai	1	2,7
Noruega	1	2,7
Bélgica	1	2,7
Estado Unidos, Canadá e Reino Unido	1	2,7
Tipo de estudo
Quase-experimental	7	18,9
Coorte prospectivo	7	18,9
Qualitativo	7	18,9
Descritivo	6	16,2
Coorte retrospectivo	5	13,5
Misto (qualitativo + descritivo)	2	5,4
Validação clínica	1	2,7
Ensaio clínico randomizado	1	2,7
Ensaio Clínico Randomizado piloto	1	2,7
Ano de publicação
2014	9	24,3
2015	7	18,9
2016	4	10,8
2017	8	21,6
2018	9	24,3

Práticas, estratégias e ferramentas com potencial impacto, positivo ou negativo, na transição do cuidado da Unidade de Terapia Intensiva para Unidade de Internação	Impacto
Fatores relacionados à Unidade de Terapia Intensiva
Alta noturna(¹¹11 Elliott M, Page K, Worrall-Carter L. Factors associated with post-intensive care unit adverse events: a clinical validation study. Nurs Crit Care. 2014 Sep;19(5):228-35. doi: 10.1111/nicc.12091 https://doi.org/10.1111/nicc.12091... ,²¹21 Ofoma UR, Dong Y, Gajic O, Pickering BW. A qualitative exploration of the discharge process and factors predisposing to readmissions to the intensive care unit. BMC Health Serv Res. 2018 Jan 5;18(6):1-9. doi: 10.1186/s12913-017-2821-z https://doi.org/10.1186/s12913-017-2821-... ,²⁴24 Stelfox HT, Leigh JP, Dodek PM, Turgeon AF, Forster AJ, Lamontagne F, et al. A multi-center prospective cohort study of patient transfers from the intensive care unit to the hospital ward. Intensive Care Med. 2017 Oct;43(10):1485-94. doi: 10.1007/s00134-017-4910-1 https://doi.org/10.1007/s00134-017-4910-... ,³²32 Azevedo LCP, de Souza IA, Zygun DA, Stelfox HT, Bagshaw SM. Association between nighttime discharge from the Intensive Care Unit and hospital mortality: a multi-center retrospective cohort study. BMC Health Serv Res. 2015 Sep 14;15(378):1-9. doi: 10.1186/s12913-015-1044-4 https://doi.org/10.1186/s12913-015-1044-... 33 Santamaria JD, Duke GJ, Pilcher DV, Cooper DJ, Moran J, Bellomo R, et al. The timing of discharge from the intensive care unit and subsequent mortality. A prospective, multicenter study. Am J Respir Crit Care Med. 2015 May 1;191(9):1033-9. doi: 10.1164/rccm.201412-2208OC https://doi.org/10.1164/rccm.201412-2208... 34 Wood SD, Coster S, Norman I. Comparing the monitoring of patients transferred from a critical care unit to hospital wards at after-hours with day transfers: an exploratory, prospective cohort study. J Adv Nurs. 2014 Dec;70(12):2757-66. doi: 10.1111/jan.12410 https://doi.org/10.1111/jan.12410... -³⁵35 Gantner D, Farley K, Bailey M, Huckson S, Hicks P, Pilcher D. Mortality related to after-hours discharge from intensive care in Australia and New Zealand, 2005-2012. Intensive Care Med. 2014 Oct;40(10):1528-35. doi: 10.1007/s00134-014-3438-x https://doi.org/10.1007/s00134-014-3438-... ), alta na mudança de turno(²⁴24 Stelfox HT, Leigh JP, Dodek PM, Turgeon AF, Forster AJ, Lamontagne F, et al. A multi-center prospective cohort study of patient transfers from the intensive care unit to the hospital ward. Intensive Care Med. 2017 Oct;43(10):1485-94. doi: 10.1007/s00134-017-4910-1 https://doi.org/10.1007/s00134-017-4910-... ) e em finais de semana(¹⁹19 Moreira HE, Verga F, Barbato M, Burghi G. Prognostic impact of the time of admission and discharge from the intensive care unit. Rev Bras Ter Intensiva. 2017 Mar;29(1):63-9. doi: 10.5935/0103-507x.20170010 https://doi.org/10.5935/0103-507x.201700... ,²¹21 Ofoma UR, Dong Y, Gajic O, Pickering BW. A qualitative exploration of the discharge process and factors predisposing to readmissions to the intensive care unit. BMC Health Serv Res. 2018 Jan 5;18(6):1-9. doi: 10.1186/s12913-017-2821-z https://doi.org/10.1186/s12913-017-2821-... )	Negativo
Comunicação inadequada das informações-chave e/ou não padronizada(²¹21 Ofoma UR, Dong Y, Gajic O, Pickering BW. A qualitative exploration of the discharge process and factors predisposing to readmissions to the intensive care unit. BMC Health Serv Res. 2018 Jan 5;18(6):1-9. doi: 10.1186/s12913-017-2821-z https://doi.org/10.1186/s12913-017-2821-... ,²³23 Graan SM, Botti M, Wood B, Redley B. Nursing handover from ICU to cardiac ward: standardised tools to reduce safety risks. Aust Crit Care. 2016 Aug;29(3):165-71. doi: 10.1016/j.aucc.2015.09.002 https://doi.org/10.1016/j.aucc.2015.09.0... 24 Stelfox HT, Leigh JP, Dodek PM, Turgeon AF, Forster AJ, Lamontagne F, et al. A multi-center prospective cohort study of patient transfers from the intensive care unit to the hospital ward. Intensive Care Med. 2017 Oct;43(10):1485-94. doi: 10.1007/s00134-017-4910-1 https://doi.org/10.1007/s00134-017-4910-... -²⁵25 van Sluisveld N, Oerlemans A, Westert G, van der Hoeven JG, Wollersheim Hub, Zegers M. Barriers and facilitators to improve safety and efficiency of the ICU discharge process: a mixed methods study. BMC Health Serv Res. 2017 Apr 4;17(251):1-12. doi: 10.1186/s12913-017-2139-x https://doi.org/10.1186/s12913-017-2139-... ,²⁷27 de Grood C, Leigh JP, Bagshaw SM, Dodek PM, Fowler RA, Forster AJ, et al. Patient, family and provider experiences with transfers from intensive care unit to hospital ward: a multicentre qualitative study. CMAJ. 2018 Jun 4;190(22):669-76. doi: 10.1503/cmaj.170588 https://doi.org/10.1503/cmaj.170588... ,³⁶36 Brown KN, Leigh JP, Kamran H, Bagshaw SM, Fowler RA, Dodek PM, et al. Transfers from intensive care unit to hospital ward: a multicentre textual analysis of physician progress notes. Crit Care. 2018 Jan 28;22(19):1-8. doi: 10.1186/s13054-018-1941-0 https://doi.org/10.1186/s13054-018-1941-... 37 Enger R, Andershed B. Nurses' experience of the transfer of ICU patients to general wards: a great responsibility and a huge challenge. J Clin Nurs. 2018 Jan;27(1-2):e186-94. doi 10.1111/jocn.13911 https://doi.org/10.1111/jocn.13911... -³⁸38 Rosenberg A, Britton MC, Feder S, Minges K, Hodshon B, Chaudhry SI, et al. A taxonomy and cultural analysis of intra-hospital patient transfers. Res Nurs Health. 2018 Aug;41(4):378-88. doi: 10.1002/nur.21875 https://doi.org/10.1002/nur.21875... )	Negativo
Alta precoce(¹¹11 Elliott M, Page K, Worrall-Carter L. Factors associated with post-intensive care unit adverse events: a clinical validation study. Nurs Crit Care. 2014 Sep;19(5):228-35. doi: 10.1111/nicc.12091 https://doi.org/10.1111/nicc.12091... ,²⁰20 Santamaria JD, Duke GJ, Pilcher DV, Cooper DJ, Moran J, Bellomo R. Readmissions to intensive care: a prospective multicenter study in Australia and New Zealand. Crit Care Med. 2017 Feb;45(2):290-7. doi: 10.1097/CCM.0000000000002066 https://doi.org/10.1097/CCM.000000000000... ,²⁸28 Cognet S, Coyer F. Discharge practices for the intensive care patient: a qualitative exploration in the general ward setting. Intensive Crit Care Nurs. 2014 Oct;30(5):292-300. doi: 10.1016/j.iccn.2014.04.004 https://doi.org/10.1016/j.iccn.2014.04.0... ,³⁷37 Enger R, Andershed B. Nurses' experience of the transfer of ICU patients to general wards: a great responsibility and a huge challenge. J Clin Nurs. 2018 Jan;27(1-2):e186-94. doi 10.1111/jocn.13911 https://doi.org/10.1111/jocn.13911... -³⁸38 Rosenberg A, Britton MC, Feder S, Minges K, Hodshon B, Chaudhry SI, et al. A taxonomy and cultural analysis of intra-hospital patient transfers. Res Nurs Health. 2018 Aug;41(4):378-88. doi: 10.1002/nur.21875 https://doi.org/10.1002/nur.21875... )	Negativo
Falta de critérios de alta(¹¹11 Elliott M, Page K, Worrall-Carter L. Factors associated with post-intensive care unit adverse events: a clinical validation study. Nurs Crit Care. 2014 Sep;19(5):228-35. doi: 10.1111/nicc.12091 https://doi.org/10.1111/nicc.12091... ,¹⁴14 van Sluisveld N, Bakhshi-Raiez F, de Keizer N, Holman R, Wester G, Wollersheim H, et al. Variation in rates of ICU readmissions and post-ICU in-hospital mortality and their association with ICU discharge practices. BMC Health Serv Res. 2017 Apr 17;17(281):1-9. doi: 10.1186/s12913-017-2234-z https://doi.org/10.1186/s12913-017-2234-... ,²¹21 Ofoma UR, Dong Y, Gajic O, Pickering BW. A qualitative exploration of the discharge process and factors predisposing to readmissions to the intensive care unit. BMC Health Serv Res. 2018 Jan 5;18(6):1-9. doi: 10.1186/s12913-017-2821-z https://doi.org/10.1186/s12913-017-2821-... ,²⁵25 van Sluisveld N, Oerlemans A, Westert G, van der Hoeven JG, Wollersheim Hub, Zegers M. Barriers and facilitators to improve safety and efficiency of the ICU discharge process: a mixed methods study. BMC Health Serv Res. 2017 Apr 4;17(251):1-12. doi: 10.1186/s12913-017-2139-x https://doi.org/10.1186/s12913-017-2139-... ,³⁷37 Enger R, Andershed B. Nurses' experience of the transfer of ICU patients to general wards: a great responsibility and a huge challenge. J Clin Nurs. 2018 Jan;27(1-2):e186-94. doi 10.1111/jocn.13911 https://doi.org/10.1111/jocn.13911... )	Negativo
Atraso no tempo de transferência(²³23 Graan SM, Botti M, Wood B, Redley B. Nursing handover from ICU to cardiac ward: standardised tools to reduce safety risks. Aust Crit Care. 2016 Aug;29(3):165-71. doi: 10.1016/j.aucc.2015.09.002 https://doi.org/10.1016/j.aucc.2015.09.0... -²⁴24 Stelfox HT, Leigh JP, Dodek PM, Turgeon AF, Forster AJ, Lamontagne F, et al. A multi-center prospective cohort study of patient transfers from the intensive care unit to the hospital ward. Intensive Care Med. 2017 Oct;43(10):1485-94. doi: 10.1007/s00134-017-4910-1 https://doi.org/10.1007/s00134-017-4910-... ,³⁹39 Bose S, Johnson AEW, Moskowitz A, Celi LA, Raffa JD. Impact of intensive care unit discharge delays on patient outcomes: a retrospective cohort study. J Intensive Care Med. 2019 Nov 1;34(11-12):1-6. doi: 10.1177/0885066618800276 https://doi.org/10.1177/0885066618800276... -⁴⁰40 Tiruvoipati R, Botha J, Fletcher J, Gangopadhyay H, Majumdar M, Vij S, et al. Intensive care discharge delay is associated with increased hospital length of stay: a multicentre prospective observational study. PLoS One. 2017 Jul 27;12(7):1-13. doi: 10.1371/journal.pone.0181827 https://doi.org/10.1371/journal.pone.018... )	Negativo
Metas indefinidas de atendimento(²¹21 Ofoma UR, Dong Y, Gajic O, Pickering BW. A qualitative exploration of the discharge process and factors predisposing to readmissions to the intensive care unit. BMC Health Serv Res. 2018 Jan 5;18(6):1-9. doi: 10.1186/s12913-017-2821-z https://doi.org/10.1186/s12913-017-2821-... ,²³23 Graan SM, Botti M, Wood B, Redley B. Nursing handover from ICU to cardiac ward: standardised tools to reduce safety risks. Aust Crit Care. 2016 Aug;29(3):165-71. doi: 10.1016/j.aucc.2015.09.002 https://doi.org/10.1016/j.aucc.2015.09.0... -²⁴24 Stelfox HT, Leigh JP, Dodek PM, Turgeon AF, Forster AJ, Lamontagne F, et al. A multi-center prospective cohort study of patient transfers from the intensive care unit to the hospital ward. Intensive Care Med. 2017 Oct;43(10):1485-94. doi: 10.1007/s00134-017-4910-1 https://doi.org/10.1007/s00134-017-4910-... ,³⁷37 Enger R, Andershed B. Nurses' experience of the transfer of ICU patients to general wards: a great responsibility and a huge challenge. J Clin Nurs. 2018 Jan;27(1-2):e186-94. doi 10.1111/jocn.13911 https://doi.org/10.1111/jocn.13911... )	Negativo
Unidade de destino incorreta(¹¹11 Elliott M, Page K, Worrall-Carter L. Factors associated with post-intensive care unit adverse events: a clinical validation study. Nurs Crit Care. 2014 Sep;19(5):228-35. doi: 10.1111/nicc.12091 https://doi.org/10.1111/nicc.12091... ,²²22 Li P, Boyd JM, Ghali WA, Stelfox HT. Stakeholder views regarding patient discharge from intensive care: suboptimal quality and opportunities for improvement. Can Respir J. 2015 Mar-Apr;22(2):109-18. doi: 10.1155/2015/457431 https://doi.org/10.1155/2015/457431... ,³⁸38 Rosenberg A, Britton MC, Feder S, Minges K, Hodshon B, Chaudhry SI, et al. A taxonomy and cultural analysis of intra-hospital patient transfers. Res Nurs Health. 2018 Aug;41(4):378-88. doi: 10.1002/nur.21875 https://doi.org/10.1002/nur.21875... )	Negativo
Ambiente inadequado para uma comunicação eficiente(²¹21 Ofoma UR, Dong Y, Gajic O, Pickering BW. A qualitative exploration of the discharge process and factors predisposing to readmissions to the intensive care unit. BMC Health Serv Res. 2018 Jan 5;18(6):1-9. doi: 10.1186/s12913-017-2821-z https://doi.org/10.1186/s12913-017-2821-... ,²³23 Graan SM, Botti M, Wood B, Redley B. Nursing handover from ICU to cardiac ward: standardised tools to reduce safety risks. Aust Crit Care. 2016 Aug;29(3):165-71. doi: 10.1016/j.aucc.2015.09.002 https://doi.org/10.1016/j.aucc.2015.09.0... )	Negativo
Comunicação verbal(¹⁴14 van Sluisveld N, Bakhshi-Raiez F, de Keizer N, Holman R, Wester G, Wollersheim H, et al. Variation in rates of ICU readmissions and post-ICU in-hospital mortality and their association with ICU discharge practices. BMC Health Serv Res. 2017 Apr 17;17(281):1-9. doi: 10.1186/s12913-017-2234-z https://doi.org/10.1186/s12913-017-2234-... ,²²22 Li P, Boyd JM, Ghali WA, Stelfox HT. Stakeholder views regarding patient discharge from intensive care: suboptimal quality and opportunities for improvement. Can Respir J. 2015 Mar-Apr;22(2):109-18. doi: 10.1155/2015/457431 https://doi.org/10.1155/2015/457431... ,²⁷27 de Grood C, Leigh JP, Bagshaw SM, Dodek PM, Fowler RA, Forster AJ, et al. Patient, family and provider experiences with transfers from intensive care unit to hospital ward: a multicentre qualitative study. CMAJ. 2018 Jun 4;190(22):669-76. doi: 10.1503/cmaj.170588 https://doi.org/10.1503/cmaj.170588... ,⁴¹41 Boyd JM, Roberts DJ, Leigh JP, Stelfox HT. Administrator perspectives on ICU-to-ward transfers and content contained in existing transfer tools: a cross-sectional survey. J Gen Intern Med. 2018 Oct;33(10):1738-45. doi: 10.1007/s11606-018-4590-8 https://doi.org/10.1007/s11606-018-4590-... 42 Häggström M, Asplund K, Kristiansen L. Important quality aspects in the transfer process. Int J Health Care Qual Assur. 2014 Mar 3;27(2):123-39. doi: 10.1108/IJHCQA-09-2012-0090 https://doi.org/10.1108/IJHCQA-09-2012-0... 43 Hoffman RL, Saucier J, Dasani S, Collins T, Holena DN, Fitzpatrick M, et al. Development and implementation of a risk identification tool to facilitate critical care transitions for high-risk surgical patients. Int J Qual Heal Care. 2017 Jun;29(3):412-9. doi: 10.1093/intqhc/mzx032 https://doi.org/10.1093/intqhc/mzx032... -⁴⁴44 Yun SH, Oh EG, Yoo YS, Kim SS, Jang YS. Development and Effects of a Transition Nursing Program for Patients and Family Caregivers at a Neurological ICU in Korea. Clin Nurs Res. 2017 Jan 1;26(1):27-46. doi: 10.1177/1054773815616973 https://doi.org/10.1177/1054773815616973... ) e escrita(¹⁴14 van Sluisveld N, Bakhshi-Raiez F, de Keizer N, Holman R, Wester G, Wollersheim H, et al. Variation in rates of ICU readmissions and post-ICU in-hospital mortality and their association with ICU discharge practices. BMC Health Serv Res. 2017 Apr 17;17(281):1-9. doi: 10.1186/s12913-017-2234-z https://doi.org/10.1186/s12913-017-2234-... ,²²22 Li P, Boyd JM, Ghali WA, Stelfox HT. Stakeholder views regarding patient discharge from intensive care: suboptimal quality and opportunities for improvement. Can Respir J. 2015 Mar-Apr;22(2):109-18. doi: 10.1155/2015/457431 https://doi.org/10.1155/2015/457431... ,²⁴24 Stelfox HT, Leigh JP, Dodek PM, Turgeon AF, Forster AJ, Lamontagne F, et al. A multi-center prospective cohort study of patient transfers from the intensive care unit to the hospital ward. Intensive Care Med. 2017 Oct;43(10):1485-94. doi: 10.1007/s00134-017-4910-1 https://doi.org/10.1007/s00134-017-4910-... ,²⁷27 de Grood C, Leigh JP, Bagshaw SM, Dodek PM, Fowler RA, Forster AJ, et al. Patient, family and provider experiences with transfers from intensive care unit to hospital ward: a multicentre qualitative study. CMAJ. 2018 Jun 4;190(22):669-76. doi: 10.1503/cmaj.170588 https://doi.org/10.1503/cmaj.170588... -²⁸28 Cognet S, Coyer F. Discharge practices for the intensive care patient: a qualitative exploration in the general ward setting. Intensive Crit Care Nurs. 2014 Oct;30(5):292-300. doi: 10.1016/j.iccn.2014.04.004 https://doi.org/10.1016/j.iccn.2014.04.0... ,³⁸38 Rosenberg A, Britton MC, Feder S, Minges K, Hodshon B, Chaudhry SI, et al. A taxonomy and cultural analysis of intra-hospital patient transfers. Res Nurs Health. 2018 Aug;41(4):378-88. doi: 10.1002/nur.21875 https://doi.org/10.1002/nur.21875... ,⁴¹41 Boyd JM, Roberts DJ, Leigh JP, Stelfox HT. Administrator perspectives on ICU-to-ward transfers and content contained in existing transfer tools: a cross-sectional survey. J Gen Intern Med. 2018 Oct;33(10):1738-45. doi: 10.1007/s11606-018-4590-8 https://doi.org/10.1007/s11606-018-4590-... ,⁴³43 Hoffman RL, Saucier J, Dasani S, Collins T, Holena DN, Fitzpatrick M, et al. Development and implementation of a risk identification tool to facilitate critical care transitions for high-risk surgical patients. Int J Qual Heal Care. 2017 Jun;29(3):412-9. doi: 10.1093/intqhc/mzx032 https://doi.org/10.1093/intqhc/mzx032... ,⁴⁵45 Bench SD, Heelas K, White C, Griffiths P. Providing critical care patients with a personalised discharge summary: a questionnaire survey and retrospective analysis exploring feasibility and effectiveness. Intensive Crit Care Nurs. 2014 Apr;30(2):69-76. doi: 10.1016/j.iccn.2013.08.007 https://doi.org/10.1016/j.iccn.2013.08.0... ) com a equipe da unidade de internação	Positivo
Acompanhamento/Consultoria de profissionais da UTI após a alta(¹³13 Stelfox HT, Bastos J, Niven DJ, Bagshaw SM, Turin TC, Gao S. Critical care transition programs and the risk of readmission or death after discharge from ICU. Intensive Care Med. 2016 Mar;42(3):401-10. doi: 10.1007/s00134-015-4173-7 https://doi.org/10.1007/s00134-015-4173-... -¹⁴14 van Sluisveld N, Bakhshi-Raiez F, de Keizer N, Holman R, Wester G, Wollersheim H, et al. Variation in rates of ICU readmissions and post-ICU in-hospital mortality and their association with ICU discharge practices. BMC Health Serv Res. 2017 Apr 17;17(281):1-9. doi: 10.1186/s12913-017-2234-z https://doi.org/10.1186/s12913-017-2234-... ,²⁴24 Stelfox HT, Leigh JP, Dodek PM, Turgeon AF, Forster AJ, Lamontagne F, et al. A multi-center prospective cohort study of patient transfers from the intensive care unit to the hospital ward. Intensive Care Med. 2017 Oct;43(10):1485-94. doi: 10.1007/s00134-017-4910-1 https://doi.org/10.1007/s00134-017-4910-... -²⁵25 van Sluisveld N, Oerlemans A, Westert G, van der Hoeven JG, Wollersheim Hub, Zegers M. Barriers and facilitators to improve safety and efficiency of the ICU discharge process: a mixed methods study. BMC Health Serv Res. 2017 Apr 4;17(251):1-12. doi: 10.1186/s12913-017-2139-x https://doi.org/10.1186/s12913-017-2139-... ,²⁷27 de Grood C, Leigh JP, Bagshaw SM, Dodek PM, Fowler RA, Forster AJ, et al. Patient, family and provider experiences with transfers from intensive care unit to hospital ward: a multicentre qualitative study. CMAJ. 2018 Jun 4;190(22):669-76. doi: 10.1503/cmaj.170588 https://doi.org/10.1503/cmaj.170588... ,³⁰30 Häggström M, Fjellner C, Öhman M, Holmström MR. Ward visits- one essential step in intensive care follow-up. An interview study with critical care nurses' and ward nurses'. Intensive Crit Care Nurs. 2018 Dec;49:21-7. doi: 10.1016/j.iccn.2018.08.011 https://doi.org/10.1016/j.iccn.2018.08.0... -³¹31 Kheir F, Shawwa K, Nguyen D, Alraiyes AH, Simeone F, Nielsen ND. A 24-hour Postintensive Care Unit transition-of-care model shortens hospital stay. J Intensive Care Med. 2016 Oct 1;31(9):597-602. doi: 10.1177/0885066615569701 https://doi.org/10.1177/0885066615569701... ,⁴⁴44 Yun SH, Oh EG, Yoo YS, Kim SS, Jang YS. Development and Effects of a Transition Nursing Program for Patients and Family Caregivers at a Neurological ICU in Korea. Clin Nurs Res. 2017 Jan 1;26(1):27-46. doi: 10.1177/1054773815616973 https://doi.org/10.1177/1054773815616973... ,⁴⁶46 Alberto L, Zotárez H, Cañete TA, Niklas JEB, Enriquez JM, Gerónimo MR, et al. A description of the ICU liaison nurse role in Argentina. Intensive Crit Care Nurs . 2014 Feb;30(1):31-7. doi: 10.1016/j.iccn.2013.07.001 https://doi.org/10.1016/j.iccn.2013.07.0... -⁴⁷47 Choi S, Lee J, Shin Y, Lee J, Jung J, Han M, et al. Effects of a medical emergency team follow-up programme on patients discharged from the medical intensive care unit to the general ward: a single-centre experience. J Eval Clin Pract. 2016 Jun;22(3):356-62. doi: 10.1111/jep.12485 https://doi.org/10.1111/jep.12485... )	Positivo
Preparo e orientações de alta para pacientes/família(²²22 Li P, Boyd JM, Ghali WA, Stelfox HT. Stakeholder views regarding patient discharge from intensive care: suboptimal quality and opportunities for improvement. Can Respir J. 2015 Mar-Apr;22(2):109-18. doi: 10.1155/2015/457431 https://doi.org/10.1155/2015/457431... 23 Graan SM, Botti M, Wood B, Redley B. Nursing handover from ICU to cardiac ward: standardised tools to reduce safety risks. Aust Crit Care. 2016 Aug;29(3):165-71. doi: 10.1016/j.aucc.2015.09.002 https://doi.org/10.1016/j.aucc.2015.09.0... -²⁴24 Stelfox HT, Leigh JP, Dodek PM, Turgeon AF, Forster AJ, Lamontagne F, et al. A multi-center prospective cohort study of patient transfers from the intensive care unit to the hospital ward. Intensive Care Med. 2017 Oct;43(10):1485-94. doi: 10.1007/s00134-017-4910-1 https://doi.org/10.1007/s00134-017-4910-... ,²⁸28 Cognet S, Coyer F. Discharge practices for the intensive care patient: a qualitative exploration in the general ward setting. Intensive Crit Care Nurs. 2014 Oct;30(5):292-300. doi: 10.1016/j.iccn.2014.04.004 https://doi.org/10.1016/j.iccn.2014.04.0... -²⁹29 Häggström M, Bäckström B. Organizing safe transitions from Intensive Care. Nurs Res Pract. 2014 Mar 24;2014:1-11. doi: 10.1155/2014/175314 https://doi.org/10.1155/2014/175314... ,⁴²42 Häggström M, Asplund K, Kristiansen L. Important quality aspects in the transfer process. Int J Health Care Qual Assur. 2014 Mar 3;27(2):123-39. doi: 10.1108/IJHCQA-09-2012-0090 https://doi.org/10.1108/IJHCQA-09-2012-0... ,⁴⁴44 Yun SH, Oh EG, Yoo YS, Kim SS, Jang YS. Development and Effects of a Transition Nursing Program for Patients and Family Caregivers at a Neurological ICU in Korea. Clin Nurs Res. 2017 Jan 1;26(1):27-46. doi: 10.1177/1054773815616973 https://doi.org/10.1177/1054773815616973... -⁴⁵45 Bench SD, Heelas K, White C, Griffiths P. Providing critical care patients with a personalised discharge summary: a questionnaire survey and retrospective analysis exploring feasibility and effectiveness. Intensive Crit Care Nurs. 2014 Apr;30(2):69-76. doi: 10.1016/j.iccn.2013.08.007 https://doi.org/10.1016/j.iccn.2013.08.0... ,⁴⁸48 Bench S, Day T, Heelas K, Hopkins P, White C, Griffiths P. Evaluating the feasibility and effectiveness of a critical care discharge information pack for patients and their families: a pilot cluster randomised controlled trial. BMJ Open. 2015 Nov;5(11):1-11. doi: 10.1136/bmjopen-2014-006852 https://doi.org/10.1136/bmjopen-2014-006... )	Positivo
Reconciliação medicamentosa/revisão dos medicamentos pelo farmacêutico(¹⁴14 van Sluisveld N, Bakhshi-Raiez F, de Keizer N, Holman R, Wester G, Wollersheim H, et al. Variation in rates of ICU readmissions and post-ICU in-hospital mortality and their association with ICU discharge practices. BMC Health Serv Res. 2017 Apr 17;17(281):1-9. doi: 10.1186/s12913-017-2234-z https://doi.org/10.1186/s12913-017-2234-... ,²²22 Li P, Boyd JM, Ghali WA, Stelfox HT. Stakeholder views regarding patient discharge from intensive care: suboptimal quality and opportunities for improvement. Can Respir J. 2015 Mar-Apr;22(2):109-18. doi: 10.1155/2015/457431 https://doi.org/10.1155/2015/457431... ,²⁴24 Stelfox HT, Leigh JP, Dodek PM, Turgeon AF, Forster AJ, Lamontagne F, et al. A multi-center prospective cohort study of patient transfers from the intensive care unit to the hospital ward. Intensive Care Med. 2017 Oct;43(10):1485-94. doi: 10.1007/s00134-017-4910-1 https://doi.org/10.1007/s00134-017-4910-... 25 van Sluisveld N, Oerlemans A, Westert G, van der Hoeven JG, Wollersheim Hub, Zegers M. Barriers and facilitators to improve safety and efficiency of the ICU discharge process: a mixed methods study. BMC Health Serv Res. 2017 Apr 4;17(251):1-12. doi: 10.1186/s12913-017-2139-x https://doi.org/10.1186/s12913-017-2139-... -²⁶26 Coon EA, Kramer NM, Fabris RR, Burkholder DB, Klaas JP, Graff-Radford J, et al. Structured handoff checklists improve clinical measures in patients discharged from the neurointensive care unit. Neurol Clin Pract. 2015 Feb;5(1):42-9. doi: 10.1212/CPJ.0000000000000094 https://doi.org/10.1212/CPJ.000000000000... ,⁴⁹49 Heselmans A, van Krieken J, Cootjans S, Nagels K, Filliers, Dillen K, et al. Medication review by a clinical pharmacist at the transfer point from ICU to ward: a randomized controlled trial. J Clin Pharm Ther. 2015 Out;40(5):578-83. doi: 10.1111/jcpt.1231410.1111/jcpt.12314 https://doi.org/10.1111/jcpt.1231410.111... )	Positivo
Checklist/ferramentas de transferência/Protocolos de alta(²²22 Li P, Boyd JM, Ghali WA, Stelfox HT. Stakeholder views regarding patient discharge from intensive care: suboptimal quality and opportunities for improvement. Can Respir J. 2015 Mar-Apr;22(2):109-18. doi: 10.1155/2015/457431 https://doi.org/10.1155/2015/457431... -²³23 Graan SM, Botti M, Wood B, Redley B. Nursing handover from ICU to cardiac ward: standardised tools to reduce safety risks. Aust Crit Care. 2016 Aug;29(3):165-71. doi: 10.1016/j.aucc.2015.09.002 https://doi.org/10.1016/j.aucc.2015.09.0... ,²⁵25 van Sluisveld N, Oerlemans A, Westert G, van der Hoeven JG, Wollersheim Hub, Zegers M. Barriers and facilitators to improve safety and efficiency of the ICU discharge process: a mixed methods study. BMC Health Serv Res. 2017 Apr 4;17(251):1-12. doi: 10.1186/s12913-017-2139-x https://doi.org/10.1186/s12913-017-2139-... 26 Coon EA, Kramer NM, Fabris RR, Burkholder DB, Klaas JP, Graff-Radford J, et al. Structured handoff checklists improve clinical measures in patients discharged from the neurointensive care unit. Neurol Clin Pract. 2015 Feb;5(1):42-9. doi: 10.1212/CPJ.0000000000000094 https://doi.org/10.1212/CPJ.000000000000... -²⁷27 de Grood C, Leigh JP, Bagshaw SM, Dodek PM, Fowler RA, Forster AJ, et al. Patient, family and provider experiences with transfers from intensive care unit to hospital ward: a multicentre qualitative study. CMAJ. 2018 Jun 4;190(22):669-76. doi: 10.1503/cmaj.170588 https://doi.org/10.1503/cmaj.170588... ,⁴¹41 Boyd JM, Roberts DJ, Leigh JP, Stelfox HT. Administrator perspectives on ICU-to-ward transfers and content contained in existing transfer tools: a cross-sectional survey. J Gen Intern Med. 2018 Oct;33(10):1738-45. doi: 10.1007/s11606-018-4590-8 https://doi.org/10.1007/s11606-018-4590-... )	Positivo
Planejamento de alta antecipada(¹⁴14 van Sluisveld N, Bakhshi-Raiez F, de Keizer N, Holman R, Wester G, Wollersheim H, et al. Variation in rates of ICU readmissions and post-ICU in-hospital mortality and their association with ICU discharge practices. BMC Health Serv Res. 2017 Apr 17;17(281):1-9. doi: 10.1186/s12913-017-2234-z https://doi.org/10.1186/s12913-017-2234-... ,²⁵25 van Sluisveld N, Oerlemans A, Westert G, van der Hoeven JG, Wollersheim Hub, Zegers M. Barriers and facilitators to improve safety and efficiency of the ICU discharge process: a mixed methods study. BMC Health Serv Res. 2017 Apr 4;17(251):1-12. doi: 10.1186/s12913-017-2139-x https://doi.org/10.1186/s12913-017-2139-... ,²⁹29 Häggström M, Bäckström B. Organizing safe transitions from Intensive Care. Nurs Res Pract. 2014 Mar 24;2014:1-11. doi: 10.1155/2014/175314 https://doi.org/10.1155/2014/175314... ,⁴⁴44 Yun SH, Oh EG, Yoo YS, Kim SS, Jang YS. Development and Effects of a Transition Nursing Program for Patients and Family Caregivers at a Neurological ICU in Korea. Clin Nurs Res. 2017 Jan 1;26(1):27-46. doi: 10.1177/1054773815616973 https://doi.org/10.1177/1054773815616973... )	Positivo
Participação do paciente e da família durante a transferência(²²22 Li P, Boyd JM, Ghali WA, Stelfox HT. Stakeholder views regarding patient discharge from intensive care: suboptimal quality and opportunities for improvement. Can Respir J. 2015 Mar-Apr;22(2):109-18. doi: 10.1155/2015/457431 https://doi.org/10.1155/2015/457431... ,²⁴24 Stelfox HT, Leigh JP, Dodek PM, Turgeon AF, Forster AJ, Lamontagne F, et al. A multi-center prospective cohort study of patient transfers from the intensive care unit to the hospital ward. Intensive Care Med. 2017 Oct;43(10):1485-94. doi: 10.1007/s00134-017-4910-1 https://doi.org/10.1007/s00134-017-4910-... ,⁴¹41 Boyd JM, Roberts DJ, Leigh JP, Stelfox HT. Administrator perspectives on ICU-to-ward transfers and content contained in existing transfer tools: a cross-sectional survey. J Gen Intern Med. 2018 Oct;33(10):1738-45. doi: 10.1007/s11606-018-4590-8 https://doi.org/10.1007/s11606-018-4590-... -⁴²42 Häggström M, Asplund K, Kristiansen L. Important quality aspects in the transfer process. Int J Health Care Qual Assur. 2014 Mar 3;27(2):123-39. doi: 10.1108/IJHCQA-09-2012-0090 https://doi.org/10.1108/IJHCQA-09-2012-0... )	Positivo
Utilização de ferramentas/escores de estratificação de risco(²³23 Graan SM, Botti M, Wood B, Redley B. Nursing handover from ICU to cardiac ward: standardised tools to reduce safety risks. Aust Crit Care. 2016 Aug;29(3):165-71. doi: 10.1016/j.aucc.2015.09.002 https://doi.org/10.1016/j.aucc.2015.09.0... ,⁴³43 Hoffman RL, Saucier J, Dasani S, Collins T, Holena DN, Fitzpatrick M, et al. Development and implementation of a risk identification tool to facilitate critical care transitions for high-risk surgical patients. Int J Qual Heal Care. 2017 Jun;29(3):412-9. doi: 10.1093/intqhc/mzx032 https://doi.org/10.1093/intqhc/mzx032... ,⁵⁰50 Ofoma UR, Chandra S, Kashyap R, Herasevich V, Ahmed A, Gajic O, et al. Findings from the implementation of a validated readmission predictive tool in the discharge workflow of a medical intensive care unit. Ann Am Thorac Soc. 2014 Jun 1;11(5):737-43. doi: 10.1513/AnnalsATS.201312-436OC https://doi.org/10.1513/AnnalsATS.201312... )	Positivo
Transferência de cuidados na beira do leito do paciente(²³23 Graan SM, Botti M, Wood B, Redley B. Nursing handover from ICU to cardiac ward: standardised tools to reduce safety risks. Aust Crit Care. 2016 Aug;29(3):165-71. doi: 10.1016/j.aucc.2015.09.002 https://doi.org/10.1016/j.aucc.2015.09.0... -²⁴24 Stelfox HT, Leigh JP, Dodek PM, Turgeon AF, Forster AJ, Lamontagne F, et al. A multi-center prospective cohort study of patient transfers from the intensive care unit to the hospital ward. Intensive Care Med. 2017 Oct;43(10):1485-94. doi: 10.1007/s00134-017-4910-1 https://doi.org/10.1007/s00134-017-4910-... ,²⁷27 de Grood C, Leigh JP, Bagshaw SM, Dodek PM, Fowler RA, Forster AJ, et al. Patient, family and provider experiences with transfers from intensive care unit to hospital ward: a multicentre qualitative study. CMAJ. 2018 Jun 4;190(22):669-76. doi: 10.1503/cmaj.170588 https://doi.org/10.1503/cmaj.170588... )	Positivo
Otimização dos sinais vitais antes da alta e redução da necessidade de cuidados intensivos(²⁹29 Häggström M, Bäckström B. Organizing safe transitions from Intensive Care. Nurs Res Pract. 2014 Mar 24;2014:1-11. doi: 10.1155/2014/175314 https://doi.org/10.1155/2014/175314... ,³⁷37 Enger R, Andershed B. Nurses' experience of the transfer of ICU patients to general wards: a great responsibility and a huge challenge. J Clin Nurs. 2018 Jan;27(1-2):e186-94. doi 10.1111/jocn.13911 https://doi.org/10.1111/jocn.13911... )	Positivo
Alta para unidades intermediárias(¹⁴14 van Sluisveld N, Bakhshi-Raiez F, de Keizer N, Holman R, Wester G, Wollersheim H, et al. Variation in rates of ICU readmissions and post-ICU in-hospital mortality and their association with ICU discharge practices. BMC Health Serv Res. 2017 Apr 17;17(281):1-9. doi: 10.1186/s12913-017-2234-z https://doi.org/10.1186/s12913-017-2234-... ,⁵⁰50 Ofoma UR, Chandra S, Kashyap R, Herasevich V, Ahmed A, Gajic O, et al. Findings from the implementation of a validated readmission predictive tool in the discharge workflow of a medical intensive care unit. Ann Am Thorac Soc. 2014 Jun 1;11(5):737-43. doi: 10.1513/AnnalsATS.201312-436OC https://doi.org/10.1513/AnnalsATS.201312... )	Positivo
Cultura institucional de valorização do processo de transição do cuidado(²⁷27 de Grood C, Leigh JP, Bagshaw SM, Dodek PM, Fowler RA, Forster AJ, et al. Patient, family and provider experiences with transfers from intensive care unit to hospital ward: a multicentre qualitative study. CMAJ. 2018 Jun 4;190(22):669-76. doi: 10.1503/cmaj.170588 https://doi.org/10.1503/cmaj.170588... )	Positivo
Realização da transferência de cuidados para seus respectivos pares por todos os membros da equipe multiprofissional(⁴³43 Hoffman RL, Saucier J, Dasani S, Collins T, Holena DN, Fitzpatrick M, et al. Development and implementation of a risk identification tool to facilitate critical care transitions for high-risk surgical patients. Int J Qual Heal Care. 2017 Jun;29(3):412-9. doi: 10.1093/intqhc/mzx032 https://doi.org/10.1093/intqhc/mzx032... )	Positivo
Fatores relacionados à Unidade de Internação
Falta de qualificação e experiência da equipe(¹¹11 Elliott M, Page K, Worrall-Carter L. Factors associated with post-intensive care unit adverse events: a clinical validation study. Nurs Crit Care. 2014 Sep;19(5):228-35. doi: 10.1111/nicc.12091 https://doi.org/10.1111/nicc.12091... ,²⁵25 van Sluisveld N, Oerlemans A, Westert G, van der Hoeven JG, Wollersheim Hub, Zegers M. Barriers and facilitators to improve safety and efficiency of the ICU discharge process: a mixed methods study. BMC Health Serv Res. 2017 Apr 4;17(251):1-12. doi: 10.1186/s12913-017-2139-x https://doi.org/10.1186/s12913-017-2139-... ,²⁸28 Cognet S, Coyer F. Discharge practices for the intensive care patient: a qualitative exploration in the general ward setting. Intensive Crit Care Nurs. 2014 Oct;30(5):292-300. doi: 10.1016/j.iccn.2014.04.004 https://doi.org/10.1016/j.iccn.2014.04.0... ,³⁰30 Häggström M, Fjellner C, Öhman M, Holmström MR. Ward visits- one essential step in intensive care follow-up. An interview study with critical care nurses' and ward nurses'. Intensive Crit Care Nurs. 2018 Dec;49:21-7. doi: 10.1016/j.iccn.2018.08.011 https://doi.org/10.1016/j.iccn.2018.08.0... ,³⁷37 Enger R, Andershed B. Nurses' experience of the transfer of ICU patients to general wards: a great responsibility and a huge challenge. J Clin Nurs. 2018 Jan;27(1-2):e186-94. doi 10.1111/jocn.13911 https://doi.org/10.1111/jocn.13911... -³⁸38 Rosenberg A, Britton MC, Feder S, Minges K, Hodshon B, Chaudhry SI, et al. A taxonomy and cultural analysis of intra-hospital patient transfers. Res Nurs Health. 2018 Aug;41(4):378-88. doi: 10.1002/nur.21875 https://doi.org/10.1002/nur.21875... ,⁴²42 Häggström M, Asplund K, Kristiansen L. Important quality aspects in the transfer process. Int J Health Care Qual Assur. 2014 Mar 3;27(2):123-39. doi: 10.1108/IJHCQA-09-2012-0090 https://doi.org/10.1108/IJHCQA-09-2012-0... )	Negativo
Redução do monitoramento(¹¹11 Elliott M, Page K, Worrall-Carter L. Factors associated with post-intensive care unit adverse events: a clinical validation study. Nurs Crit Care. 2014 Sep;19(5):228-35. doi: 10.1111/nicc.12091 https://doi.org/10.1111/nicc.12091... ,¹⁴14 van Sluisveld N, Bakhshi-Raiez F, de Keizer N, Holman R, Wester G, Wollersheim H, et al. Variation in rates of ICU readmissions and post-ICU in-hospital mortality and their association with ICU discharge practices. BMC Health Serv Res. 2017 Apr 17;17(281):1-9. doi: 10.1186/s12913-017-2234-z https://doi.org/10.1186/s12913-017-2234-... ,³⁴34 Wood SD, Coster S, Norman I. Comparing the monitoring of patients transferred from a critical care unit to hospital wards at after-hours with day transfers: an exploratory, prospective cohort study. J Adv Nurs. 2014 Dec;70(12):2757-66. doi: 10.1111/jan.12410 https://doi.org/10.1111/jan.12410... ,³⁷37 Enger R, Andershed B. Nurses' experience of the transfer of ICU patients to general wards: a great responsibility and a huge challenge. J Clin Nurs. 2018 Jan;27(1-2):e186-94. doi 10.1111/jocn.13911 https://doi.org/10.1111/jocn.13911... )	Negativo
Dimensionamento de pessoal reduzido(¹¹11 Elliott M, Page K, Worrall-Carter L. Factors associated with post-intensive care unit adverse events: a clinical validation study. Nurs Crit Care. 2014 Sep;19(5):228-35. doi: 10.1111/nicc.12091 https://doi.org/10.1111/nicc.12091... ,²⁵25 van Sluisveld N, Oerlemans A, Westert G, van der Hoeven JG, Wollersheim Hub, Zegers M. Barriers and facilitators to improve safety and efficiency of the ICU discharge process: a mixed methods study. BMC Health Serv Res. 2017 Apr 4;17(251):1-12. doi: 10.1186/s12913-017-2139-x https://doi.org/10.1186/s12913-017-2139-... ,²⁷27 de Grood C, Leigh JP, Bagshaw SM, Dodek PM, Fowler RA, Forster AJ, et al. Patient, family and provider experiences with transfers from intensive care unit to hospital ward: a multicentre qualitative study. CMAJ. 2018 Jun 4;190(22):669-76. doi: 10.1503/cmaj.170588 https://doi.org/10.1503/cmaj.170588... ,³⁷37 Enger R, Andershed B. Nurses' experience of the transfer of ICU patients to general wards: a great responsibility and a huge challenge. J Clin Nurs. 2018 Jan;27(1-2):e186-94. doi 10.1111/jocn.13911 https://doi.org/10.1111/jocn.13911... )	Negativo
Falta de recursos materiais disponíveis(²¹21 Ofoma UR, Dong Y, Gajic O, Pickering BW. A qualitative exploration of the discharge process and factors predisposing to readmissions to the intensive care unit. BMC Health Serv Res. 2018 Jan 5;18(6):1-9. doi: 10.1186/s12913-017-2821-z https://doi.org/10.1186/s12913-017-2821-... ,²⁵25 van Sluisveld N, Oerlemans A, Westert G, van der Hoeven JG, Wollersheim Hub, Zegers M. Barriers and facilitators to improve safety and efficiency of the ICU discharge process: a mixed methods study. BMC Health Serv Res. 2017 Apr 4;17(251):1-12. doi: 10.1186/s12913-017-2139-x https://doi.org/10.1186/s12913-017-2139-... ,²⁷27 de Grood C, Leigh JP, Bagshaw SM, Dodek PM, Fowler RA, Forster AJ, et al. Patient, family and provider experiences with transfers from intensive care unit to hospital ward: a multicentre qualitative study. CMAJ. 2018 Jun 4;190(22):669-76. doi: 10.1503/cmaj.170588 https://doi.org/10.1503/cmaj.170588... )	Negativo
Maior tempo até a primeira avaliação clínica do paciente(¹⁴14 van Sluisveld N, Bakhshi-Raiez F, de Keizer N, Holman R, Wester G, Wollersheim H, et al. Variation in rates of ICU readmissions and post-ICU in-hospital mortality and their association with ICU discharge practices. BMC Health Serv Res. 2017 Apr 17;17(281):1-9. doi: 10.1186/s12913-017-2234-z https://doi.org/10.1186/s12913-017-2234-... ,²⁴24 Stelfox HT, Leigh JP, Dodek PM, Turgeon AF, Forster AJ, Lamontagne F, et al. A multi-center prospective cohort study of patient transfers from the intensive care unit to the hospital ward. Intensive Care Med. 2017 Oct;43(10):1485-94. doi: 10.1007/s00134-017-4910-1 https://doi.org/10.1007/s00134-017-4910-... ,⁴³43 Hoffman RL, Saucier J, Dasani S, Collins T, Holena DN, Fitzpatrick M, et al. Development and implementation of a risk identification tool to facilitate critical care transitions for high-risk surgical patients. Int J Qual Heal Care. 2017 Jun;29(3):412-9. doi: 10.1093/intqhc/mzx032 https://doi.org/10.1093/intqhc/mzx032... )	Negativo
Fragmentação do cuidado em várias equipes(¹¹11 Elliott M, Page K, Worrall-Carter L. Factors associated with post-intensive care unit adverse events: a clinical validation study. Nurs Crit Care. 2014 Sep;19(5):228-35. doi: 10.1111/nicc.12091 https://doi.org/10.1111/nicc.12091... )	Negativo
Contato prévio da equipe receptora com o paciente(²⁴24 Stelfox HT, Leigh JP, Dodek PM, Turgeon AF, Forster AJ, Lamontagne F, et al. A multi-center prospective cohort study of patient transfers from the intensive care unit to the hospital ward. Intensive Care Med. 2017 Oct;43(10):1485-94. doi: 10.1007/s00134-017-4910-1 https://doi.org/10.1007/s00134-017-4910-... ,²⁹29 Häggström M, Bäckström B. Organizing safe transitions from Intensive Care. Nurs Res Pract. 2014 Mar 24;2014:1-11. doi: 10.1155/2014/175314 https://doi.org/10.1155/2014/175314... )	Positivo
Fatores relacionados à Unidade de Terapia Intensiva e à Unidade de Internação
Responsabilização das informações emitidas e recebidas(²³23 Graan SM, Botti M, Wood B, Redley B. Nursing handover from ICU to cardiac ward: standardised tools to reduce safety risks. Aust Crit Care. 2016 Aug;29(3):165-71. doi: 10.1016/j.aucc.2015.09.002 https://doi.org/10.1016/j.aucc.2015.09.0... ,²⁹29 Häggström M, Bäckström B. Organizing safe transitions from Intensive Care. Nurs Res Pract. 2014 Mar 24;2014:1-11. doi: 10.1155/2014/175314 https://doi.org/10.1155/2014/175314... ,⁴³43 Hoffman RL, Saucier J, Dasani S, Collins T, Holena DN, Fitzpatrick M, et al. Development and implementation of a risk identification tool to facilitate critical care transitions for high-risk surgical patients. Int J Qual Heal Care. 2017 Jun;29(3):412-9. doi: 10.1093/intqhc/mzx032 https://doi.org/10.1093/intqhc/mzx032... )	Positivo
Alerta de risco de readmissão(⁴³43 Hoffman RL, Saucier J, Dasani S, Collins T, Holena DN, Fitzpatrick M, et al. Development and implementation of a risk identification tool to facilitate critical care transitions for high-risk surgical patients. Int J Qual Heal Care. 2017 Jun;29(3):412-9. doi: 10.1093/intqhc/mzx032 https://doi.org/10.1093/intqhc/mzx032... ,⁵⁰50 Ofoma UR, Chandra S, Kashyap R, Herasevich V, Ahmed A, Gajic O, et al. Findings from the implementation of a validated readmission predictive tool in the discharge workflow of a medical intensive care unit. Ann Am Thorac Soc. 2014 Jun 1;11(5):737-43. doi: 10.1513/AnnalsATS.201312-436OC https://doi.org/10.1513/AnnalsATS.201312... )	Positivo

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[1] Autor correspondente: Michele Elisa Weschenfelder Hervé. E-mail: mweschenfelder@hcpa.edu.br