TY - JOUR AU - Sleeuwen, D. van AU - Laar, F.A. van de AU - Geense, W.W. AU - Boogaard, M. van den AU - Zegers, M. PY - 2020 UR - https://hdl.handle.net/2066/229434 AB - BACKGROUND: Family caregivers of former intensive care unit (ICU) patients may suffer from physical and mental problems owing to ICU hospitalisation of their loved ones. These problems can have a major impact on their daily lives. Little is known about experienced consequences of ICU hospitalisation on caregivers in general practice. AIM: To explore health problems in family caregivers of former ICU patients and the consequences in their daily lives. DESIGN & SETTING: Semi-structured interviews with family caregivers of former critically ill patients treated in a Dutch ICU. METHOD: Purposively sampled relatives of former ICU patients were interviewed between April and May 2019. Interviews were conducted until data saturation was reached. Interviews were then thematically analysed. RESULTS: In total, 13 family caregivers were interviewed. The interviews took place 3 months to 3 years after ICU discharge. Expressed problems were categorised into six themes: (1) physical functioning (for example, tiredness, headache, and feeling sick more often); (2) mental health (for example, anxiety, more stress and difficulty in expressing emotions); (3) existential dimension and future (for example, uncertainty about the future); (4) quality of life (for example, losing freedom in life); (5) relationship and social participation (for example, experiencing a lack of understanding); and (6) daily functioning (for example, stopping working). CONCLUSION: Caregivers experience several health problems, even years after their relative's ICU episode. Healthcare providers should be focused not only on former ICU patients' health, but also on their caregivers', and need to signal and identify caregivers' health problems earlier in order to give them the appropriate care and support they need. TI - Health problems among family caregivers of former intensive care unit (ICU) patients: an interview study SN - 2398-3795 IS - iss. 4 JF - BJGP Open VL - vol. 4 DO - https://doi.org/10.3399/bjgpopen20X101061 L1 - https://repository.ubn.ru.nl/bitstream/handle/2066/229434/229434.pdf?sequence=1 ER - TY - JOUR AU - Hanskamp-Sebregts, M.E.C. AU - Zegers, M. AU - Boeijen, W.M.J. AU - Wollersheim, H.C. AU - Gurp, P.J. van AU - Westert, G.P. PY - 2019 UR - https://hdl.handle.net/2066/209687 TI - Process evaluation of the effects of patient safety auditing in hospital care (part 2) EP - 441 SN - 1353-4505 IS - iss. 6 SP - 433 JF - International Journal for Quality in Health Care VL - vol. 31 DO - https://doi.org/10.1093/intqhc/mzy173 L1 - https://repository.ubn.ru.nl/bitstream/handle/2066/209687/209687.pdf?sequence=1 ER - TY - JOUR AU - Hanskamp-Sebregts, M.E. AU - Zegers, M. AU - Westert, G.P. AU - Boeijen, W.M.J. AU - Teerenstra, S. AU - Gurp, P.J.M. van AU - Wollersheim, H.C. PY - 2019 UR - https://hdl.handle.net/2066/215427 AB - OBJECTIVE: To evaluate the effectiveness of internal auditing in hospital care focussed on improving patient safety. DESIGN, SETTING AND PARTICIPANTS: A before-and-after mixed-method evaluation study was carried out in eight departments of a university medical center in the Netherlands. INTERVENTION(S): Internal auditing and feedback focussed on improving patient safety. MAIN OUTCOME MEASURE(S): The effect of internal auditing was assessed 15 months after the audit, using linear mixed models, on the patient, professional, team and departmental levels. The measurement methods were patient record review on adverse events (AEs), surveys regarding patient experiences, safety culture and team climate, analysis of administrative hospital data (standardized mortality rate, SMR) and safety walk rounds (SWRs) to observe frontline care processes on safety. RESULTS: The AE rate decreased from 36.1% to 31.3% and the preventable AE rate from 5.5% to 3.6%; however, the differences before and after auditing were not statistically significant. The patient-reported experience measures regarding patient safety improved slightly over time (P < 0.001). The SMR, patient safety culture and team climate remained unchanged after the internal audit. The SWRs showed that medication safety and information security were improved (P < 0.05). CONCLUSIONS: Internal auditing was associated with improved patient experiences and observed safety on wards. No effects were found on adverse outcomes, safety culture and team climate 15 months after the internal audit. TI - Effects of patient safety auditing in hospital care: results of a mixed-method evaluation (part 1) EP - 15 SN - 1353-4505 IS - iss. 7 SP - 8 JF - International Journal for Quality in Health Care VL - vol. 31 DO - https://doi.org/10.1093/intqhc/mzy134 L1 - https://repository.ubn.ru.nl/bitstream/handle/2066/215427/215427.pdf?sequence=1 ER - TY - JOUR AU - Smeets, X.J.N.M. AU - Costa, D.W. da AU - Fockens, P. AU - Mulder, C.J. AU - Timmer, R. AU - Kievit, W. AU - Zegers, M. AU - Bruno, M.J. AU - Besselink, M.G.H. AU - Vleggaar, F.P. AU - Hulst, R.W. van der AU - Poen, A.C. AU - Heine, G.D.N. AU - Venneman, N.G. AU - Kolkman, J.J. AU - Baak, L.C. AU - Romkens, T.E.H. AU - Dijk, S.M. van AU - Hallensleben, N.D. AU - Vrie, W. van de AU - Seerden, T.C. AU - Tan, A. AU - Voorburg, A. AU - Poley, J.W. AU - Witteman, B.J. AU - Bhalla, A. AU - Hadithi, M. AU - Thijs, W.J. AU - Schwartz, M.P. AU - Vrolijk, J.M. AU - Verdonk, R.C. AU - Delft, F. von AU - Keulemans, Y. AU - Goor, H. van AU - Drenth, J.P.H. AU - Geenen, E.J.M. van PY - 2018 UR - https://hdl.handle.net/2066/190882 AB - BACKGROUND: Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) is the most common complication of ERCP and may run a severe course. Evidence suggests that vigorous periprocedural hydration can prevent PEP, but studies to date have significant methodological drawbacks. Importantly, evidence for its added value in patients already receiving prophylactic rectal non-steroidal anti-inflammatory drugs (NSAIDs) is lacking and the cost-effectiveness of the approach has not been investigated. We hypothesize that combination therapy of rectal NSAIDs and periprocedural hydration would significantly lower the incidence of post-ERCP pancreatitis compared to rectal NSAIDs alone in moderate- to high-risk patients undergoing ERCP. METHODS: The FLUYT trial is a multicenter, parallel group, open label, superiority randomized controlled trial. A total of 826 moderate- to high-risk patients undergoing ERCP that receive prophylactic rectal NSAIDs will be randomized to a control group (no fluids or normal saline with a maximum of 1.5 mL/kg/h and 3 L/24 h) or intervention group (lactated Ringer's solution with 20 mL/kg over 60 min at start of ERCP, followed by 3 mL/kg/h for 8 h thereafter). The primary endpoint is the incidence of post-ERCP pancreatitis. Secondary endpoints include PEP severity, hydration-related complications, and cost-effectiveness. DISCUSSION: The FLUYT trial design, including hydration schedule, fluid type, and sample size, maximize its power of identifying a potential difference in post-ERCP pancreatitis incidence in patients receiving prophylactic rectal NSAIDs. TRIAL REGISTRATION: EudraCT: 2015-000829-37 . Registered on 18 February 2015. ISRCTN: 13659155 . Registered on 18 May 2015. TI - Fluid hydration to prevent post-ERCP pancreatitis in average- to high-risk patients receiving prophylactic rectal NSAIDs (FLUYT trial): study protocol for a randomized controlled trial SN - 1745-6215 JF - Trials VL - vol. 19 DO - https://doi.org/10.1186/s13063-018-2583-x L1 - https://repository.ubn.ru.nl/bitstream/handle/2066/190882/190882.pdf?sequence=1 ER - TY - JOUR AU - Gelderen, S.C. van AU - Zegers, M. AU - Robben, P.B. AU - Boeijen, W.M.J. AU - Westert, G.P. AU - Wollersheim, H.C.H. PY - 2018 UR - https://hdl.handle.net/2066/198467 TI - Important factors for effective patient safety governance auditing: a questionnaire survey SN - 1472-6963 JF - BMC Health Services Research VL - vol. 18 DO - https://doi.org/10.1186/s12913-018-3577-9 L1 - https://repository.ubn.ru.nl/bitstream/handle/2066/198467/198467.pdf?sequence=1 ER - TY - JOUR AU - Verlaat, C.W.M. AU - Starre, C. van der AU - Hazelzet, J.A. AU - Tibboel, Dick AU - Hoeven, J.J. van der AU - Lemson, J. AU - Zegers, M. PY - 2018 UR - https://hdl.handle.net/2066/194768 TI - The occurrence of adverse events in low-risk non-survivors in pediatric intensive care patients: an exploratory study EP - 1358 SN - 0340-6199 IS - iss. 9 SP - 1351 JF - European Journal of Pediatrics VL - vol. 177 DO - https://doi.org/10.1007/s00431-018-3194-y L1 - https://repository.ubn.ru.nl/bitstream/handle/2066/194768/194768.pdf?sequence=1 ER - TY - JOUR AU - Sluisveld, N. van AU - Oerlemans, A.J.M. AU - Westert, G.P. AU - Hoeven, J.G. van der AU - Wollersheim, H.C. AU - Zegers, M. PY - 2017 UR - https://hdl.handle.net/2066/174300 AB - BACKGROUND: Evidence indicates that suboptimal clinical handover from the intensive care unit (ICU) to general wards leads to unnecessary ICU readmissions and increased mortality. We aimed to gain insight into barriers and facilitators to implement and use ICU discharge practices. METHODS: A mixed methods approach was conducted, using 1) 23 individual and four focus group interviews, with post-ICU patients, ICU managers, and nurses and physicians working in the ICU or general ward of ten Dutch hospitals, and 2) a questionnaire survey, which contained 27 statements derived from the interviews, and was completed by 166 ICU physicians (21.8%) from 64 Dutch hospitals (71.1% of the total of 90 Dutch hospitals). RESULTS: The interviews resulted in 66 barriers and facilitators related to: the intervention (e.g., feasibility); the professional (e.g., attitude towards checklists); social factors (e.g., presence or absence of a culture of feedback); and the organisation (e.g., financial resources). A facilitator considered important by ICU physicians was a checklist to structure discharge communication (92.2%). Barriers deemed important were lack of a culture of feedback (55.4%), an absence of discharge criteria (23.5%), and an overestimation of the capabilities of general wards to care for complex patients by ICU physicians (74.7%). CONCLUSIONS: Based on the barriers and facilitators found in this study, improving handover communication, formulating specific discharge criteria, stimulating a culture of feedback, and preventing overestimation of the general ward are important to effectively improve the ICU discharge process. TI - Barriers and facilitators to improve safety and efficiency of the ICU discharge process: a mixed methods study EP - 251 SN - 1472-6963 IS - iss. 1 SP - 251 JF - BMC Health Services Research VL - vol. 17 DO - https://doi.org/10.1186/s12913-017-2139-x L1 - https://repository.ubn.ru.nl/bitstream/handle/2066/174300/174300.pdf?sequence=1 ER - TY - JOUR AU - Sluisveld, N. van AU - Bakhshi-Raiez, F. AU - Keizer, N. de AU - Holman, R. AU - Westert, G.P. AU - Wollersheim, H.C. AU - Hoeven, J.G. van der AU - Zegers, M. PY - 2017 UR - https://hdl.handle.net/2066/174318 AB - BACKGROUND: Variation in intensive care unit (ICU) readmissions and in-hospital mortality after ICU discharge may indicate potential for improvement and could be explained by ICU discharge practices. Our objective was threefold: (1) describe variation in rates of ICU readmissions within 48 h and post-ICU in-hospital mortality, (2) describe ICU discharge practices in Dutch hospitals, and (3) study the association between rates of ICU readmissions within 48 h and post-ICU in-hospital mortality and ICU discharge practices. METHODS: We analysed data on 42,040 admissions to 82 (91.1%) Dutch ICUs in 2011 from the Dutch National Intensive Care Evaluation (NICE) registry to describe variation in standardized ICU readmission and post-ICU mortality rates using funnel-plots. We send a questionnaire to all Dutch ICUs. 75 ICUs responded and their questionnaire data could be linked to 38,498 admissions in the NICE registry. Generalized estimation equations analyses were used to study the association between ICU readmissions and post-ICU mortality rates and the identified discharge practices, i.e. (1) ICU discharge criteria; (2) bed managers; (3) early discharge planning; (4) step-down facilities; (5) medication reconciliation; (6) verbal and written handover; (7) monitoring of post-ICU patients; and (8) consulting ICU nurses. In all analyses, the outcomes were corrected for patient-related confounding factors. RESULTS: The standardized rate of ICU readmissions varied between 0.14 and 2.67 and 20.8% of the hospitals fell outside the 95% control limits and 3.6% outside the 99.8% control limits. The standardized rate of post-ICU mortality varied between 0.07 and 2.07 and 17.1% of the hospitals fell outside the 95% control limits and 4.9% outside the 99.8% control limits. We could not demonstrate an association between the eight ICU discharge practices and rates of ICU readmissions or post-ICU in-hospital mortality. Implementing a higher number of ICU discharge practices was also not associated with better patient outcomes. CONCLUSIONS: We found both variation in patient outcomes and variation in ICU discharge practices between ICUs. However, we found no association between discharge practices and rates of ICU readmissions or post-ICU mortality. Further research is necessary to find factors, which may influence these patient outcomes, in order to improve quality of care. TI - Variation in rates of ICU readmissions and post-ICU in-hospital mortality and their association with ICU discharge practices SN - 1472-6963 IS - iss. 1 SP - 281 JF - BMC Health Services Research VL - vol. 17 DO - https://doi.org/10.1186/s12913-017-2234-z L1 - https://repository.ubn.ru.nl/bitstream/handle/2066/174318/174318.pdf?sequence=1 ER - TY - JOUR AU - Gelderen, S.C. van AU - Zegers, M. AU - Boeijen, W.M.J. AU - Westert, G.P. AU - Robben, P.B. AU - Wollersheim, H.C.H. PY - 2017 UR - https://hdl.handle.net/2066/177345 AB - OBJECTIVES: Hospital boards are legally responsible for safe healthcare. They need tools to assist them in their task of governing patient safety. Almost every Dutch hospital performs internal audits, but the effectiveness of these audits for hospital governance has never been evaluated. The aim of this study is to evaluate the organisation of internal audits and their effectiveness for hospitals boards to govern patient safety. DESIGN AND SETTING: A mixed-methods study consisting of a questionnaire regarding the organisation of internal audits among all Dutch hospitals (n=89) and interviews with stakeholders regarding the audit process and experienced effectiveness of audits within six hospitals. RESULTS: Response rate of the questionnaire was 76% and 43 interviews were held. In every responding hospital, the internal audits followed the plan-do-check-act cycle. Every hospital used interviews, document analysis and site visits as input for the internal audit. Boards stated that effective aspects of internal audits were their multidisciplinary scope, their structured and in-depth approach, the usability to monitor improvement activities and to change hospital policy and the fact that results were used in meetings with staff and boards of supervisors. The qualitative methods (interviews and site visits) used in internal audits enable the identification of soft signals such as unsafe culture or communication and collaboration problems. Reported disadvantages were the low frequency of internal audits and the absence of soft signals in the actual audit reports. CONCLUSION: This study shows that internal audits are regarded as effective for patient safety governance, as they help boards to identify patient safety problems, proactively steer patient safety and inform boards of supervisors on the status of patient safety. The description of the Dutch internal audits makes these audits replicable to other healthcare organisations in different settings, enabling hospital boards to complement their systems to govern patient safety. TI - Evaluation of the organisation and effectiveness of internal audits to govern patient safety in hospitals: a mixed-methods study SN - 2044-6055 IS - iss. 7 SP - e015506 JF - BMJ Open VL - vol. 7 DO - https://doi.org/10.1136/bmjopen-2016-015506 L1 - https://repository.ubn.ru.nl/bitstream/handle/2066/177345/177345.pdf?sequence=1 ER - TY - JOUR AU - Geense, W.W. AU - Zegers, M. AU - Vermeulen, H. AU - Boogaard, M.H.W.A. van den AU - Hoeven, J.G. van der PY - 2017 UR - https://hdl.handle.net/2066/182346 AB - INTRODUCTION: Due to advances in critical care medicine, more patients survive their critical illness. However, intensive care unit (ICU) survivors often experience long-term physical, cognitive and mental problems, summarised as post-intensive care syndrome (PICS), impacting their health-related quality of life (HRQoL). In what frequency PICS occurs, and to what extent this influences ICU survivors' HRQoL, is mostly unknown. The aims of this study are therefore to study the: (1) 5-year patient outcomes, (2) predictors for PICS, (3) ratio between HRQoL of ICU survivors and healthcare-related costs, and (4) care and support needs. METHODS: The MONITOR-IC study is a multicentre prospective controlled cohort study, carried out in ICUs in four Dutch hospitals. Patients will be included between July 2016 and July 2021 and followed for 5 years. We estimated to include 12000 ICU patients. Outcomes are the HRQoL, physical, cognitive and mental symptoms, ICU survivors' care and support needs, healthcare use and related costs. A control cohort of otherwise seriously ill patients will be assembled to compare long-term patient-reported outcomes. We will use a mixed methods design, including questionnaires, medical data from patient records, cost data from health insurance companies and interviews with patients and family members. ETHICS AND DISSEMINATION: Insights from this study will be used to inform ICU patients and their family members about long-term consequences of ICU care, and to develop prediction and screening instruments to detect patients at risk for PICS. Subsequently, tailored interventions can be developed and implemented to prevent and mitigate long-term consequences. Additionally, insights into the ratio between HRQoL of ICU patients and related healthcare costs during 5 years after ICU admission can be used to discuss the added value of ICU care from a community perspective. The study has been approved by the research ethics committee of the Radboud University Medical Center (2016-2724). CLINICAL TRIAL REGISTRATION: NCT03246334. TI - MONITOR-IC study, a mixed methods prospective multicentre controlled cohort study assessing 5-year outcomes of ICU survivors and related healthcare costs: a study protocol SN - 2044-6055 IS - iss. 11 JF - BMJ Open VL - vol. 7 DO - https://doi.org/10.1136/bmjopen-2017-018006 L1 - https://repository.ubn.ru.nl/bitstream/handle/2066/182346/182346.pdf?sequence=1 ER - TY - JOUR AU - Oerlemans, A.J.M. AU - Wollersheim, H.C.H. AU - Sluisveld, N. van AU - Hoeven, J.G. van der AU - Dekkers, W.J.M. AU - Zegers, M. PY - 2016 UR - https://hdl.handle.net/2066/171342 AB - BACKGROUND: Internationally, there is no consensus on how to best deal with admission requests in cases of full ICU bed occupancy. Knowledge about the degree of dissension and insight into the reasons for this dissension is lacking. Information about the opinion of ICU physicians can be used to improve decision-making regarding allocation of ICU resources. The aim of this study was to: Assess which factors play a role in the decision-making process regarding the admission of ICU patients; Assess the adherence to a Dutch guideline pertaining to rationing of ICU resources; Investigate factors influencing the adherence to this guideline. METHODS: In March 2013, an online questionnaire was sent to all ICU physician members (n = 761, in 90 hospitals) of the Dutch Society for Intensive Care. RESULTS: 166 physicians (21.8 %) working in 64 different Dutch hospitals (71.1 %) completed the questionnaire. Factors associated with a patient's physical condition and quality of life were generally considered most important in admission decisions. Scenario-based adherence to the Dutch guideline "Admission request in case of full ICU bed occupancy" was found to be low (adherence rate 50.0 %). There were two main reasons for this poor compliance: unfamiliarity with the guideline and disagreement with the fundamental approach underlying the guideline. CONCLUSIONS: Dutch ICU physicians disagree about how to deal with admission requests in cases of full ICU bed occupancy. The results of this study contribute to the discussion about the fundamental principles regarding admission of ICU patients in case of full bed occupancy. TI - Rationing in the intensive care unit in case of full bed occupancy: a survey among intensive care unit physicians SN - 1471-2253 JF - BMC Anesthesiology VL - vol. 16 DO - https://doi.org/10.1186/s12871-016-0190-5 L1 - https://repository.ubn.ru.nl/bitstream/handle/2066/171342/171342.pdf?sequence=1 ER - TY - JOUR AU - Zegers, H.W. AU - Hesselink, G. AU - Geense, W. AU - Vincent, C. AU - Wollersheim, H. PY - 2016 UR - https://hdl.handle.net/2066/172502 AB - OBJECTIVE: To provide an overview of effective interventions aimed at reducing rates of adverse events in hospitals. DESIGN: Systematic review of systematic reviews. DATA SOURCES: PubMed, CINAHL, PsycINFO, the Cochrane Library and EMBASE were searched for systematic reviews published until October 2015. STUDY SELECTION: English-language systematic reviews of interventions aimed at reducing adverse events in hospitals, including studies with an experimental design and reporting adverse event rates, were included. Two reviewers independently assessed each study's quality and extracted data on the study population, study design, intervention characteristics and adverse patient outcomes. RESULTS: Sixty systematic reviews with moderate to high quality were included. Statistically significant pooled effect sizes were found for 14 types of interventions, including: (1) multicomponent interventions to prevent delirium; (2) rapid response teams to reduce cardiopulmonary arrest and mortality rates; (3) pharmacist interventions to reduce adverse drug events; (4) exercises and multicomponent interventions to prevent falls; and (5) care bundle interventions, checklists and reminders to reduce infections. Most (82%) of the significant effect sizes were based on 5 or fewer primary studies with an experimental study design. CONCLUSIONS: The evidence for patient-safety interventions implemented in hospitals worldwide is weak. The findings address the need to invest in high-quality research standards in order to identify interventions that have a real impact on patient safety. Interventions to prevent delirium, cardiopulmonary arrest and mortality, adverse drug events, infections and falls are most effective and should therefore be prioritised by clinicians. TI - Evidence-based interventions to reduce adverse events in hospitals: a systematic review of systematic reviews SN - 2044-6055 IS - iss. 9 SP - e012555 JF - BMJ Open VL - vol. 6 DO - https://doi.org/10.1136/bmjopen-2016-012555 L1 - https://repository.ubn.ru.nl/bitstream/handle/2066/172502/172502.pdf?sequence=1 ER - TY - JOUR AU - Hanskamp-Sebregts, M.E.C. AU - Zegers, M. AU - Vincent, C. AU - Gurp, P.J.M. van AU - Vet, H.C. de AU - Wollersheim, H.C. PY - 2016 UR - https://hdl.handle.net/2066/170948 AB - OBJECTIVES: Record review is the most used method to quantify patient safety. We systematically reviewed the reliability and validity of adverse event detection with record review. DESIGN: A systematic review of the literature. METHODS: We searched PubMed, EMBASE, CINAHL, PsycINFO and the Cochrane Library and from their inception through February 2015. We included all studies that aimed to describe the reliability and/or validity of record review. Two reviewers conducted data extraction. We pooled kappa values (kappa) and analysed the differences in subgroups according to number of reviewers, reviewer experience and training level, adjusted for the prevalence of adverse events. RESULTS: In 25 studies, the psychometric data of the Global Trigger Tool (GTT) and the Harvard Medical Practice Study (HMPS) were reported and 24 studies were included for statistical pooling. The inter-rater reliability of the GTT and HMPS showed a pooled kappa of 0.65 and 0.55, respectively. The inter-rater agreement was statistically significantly higher when the group of reviewers within a study consisted of a maximum five reviewers. We found no studies reporting on the validity of the GTT and HMPS. CONCLUSIONS: The reliability of record review is moderate to substantial and improved when a small group of reviewers carried out record review. The validity of the record review method has never been evaluated, while clinical data registries, autopsy or direct observations of patient care are potential reference methods that can be used to test concurrent validity. TI - Measurement of patient safety: a systematic review of the reliability and validity of adverse event detection with record review SN - 2044-6055 IS - iss. 8 SP - e011078 JF - BMJ Open VL - vol. 6 DO - https://doi.org/10.1136/bmjopen-2016-011078 L1 - https://repository.ubn.ru.nl/bitstream/handle/2066/170948/170948.pdf?sequence=1 ER - TY - JOUR AU - Sluisveld, P.H.J. van AU - Hesselink, G.J. AU - Hoeven, J.G. van der AU - Westert, G.P. AU - Wollersheim, H.C. AU - Zegers, M. PY - 2015 UR - https://hdl.handle.net/2066/153116 AB - PURPOSE: To systematically review and evaluate the effectiveness of interventions in order to improve the safety and efficiency of patient handover between intensive care unit (ICU) and general ward healthcare professionals at ICU discharge. METHODS: PubMed, CINAHL, PsycINFO, EMBASE, Web of Science, and the Cochrane Library were searched for intervention studies with the aim to improve clinical handover between ICU and general ward healthcare professionals that had been published up to and including June 2013. The methods for article inclusion and data analysis were pre-specified and aligned with recommendations outlined in the PRISMA guideline. Two reviewers independently extracted data (study purpose, setting, population, method of sampling, sample size, intervention characteristics, outcome, and implementation activities) and assessed the quality of the included studies. RESULTS: From the 6,591 citations initially extracted from the six databases, we included 11 studies in this review. Of these, six (55 %) reported statistically significant effects. Effective interventions included liaison nurses to improve communication and coordination of care and forms to facilitate timely, complete and accurate handover information. Effective interventions resulted in improved continuity of care (e.g., reduced discharge delay) and in reduced adverse events. Inconsistent effects were observed for use of care, namely, reduction of length of stay versus increase of readmissions to higher care. No statistically significant effects were found in the reduction of mortality. The overall methodological quality of the 11 studies reviewed was relatively low, with an average score of 4.5 out of 11 points. CONCLUSIONS: This review shows that liaison nurses and handover forms are promising interventions to improve the quality of patient handover between the ICU and general ward. More robust evidence is needed on the effectiveness of interventions aiming to improve ICU handover and supportive implementation strategies. TI - Improving clinical handover between intensive care unit and general ward professionals at intensive care unit discharge EP - 604 SN - 0342-4642 IS - iss. 4 SP - 589 JF - Intensive Care Medicine VL - vol. 41 DO - https://doi.org/10.1007/s00134-015-3666-8 L1 - https://repository.ubn.ru.nl/bitstream/handle/2066/153116/153116.pdf?sequence=1 ER - TY - JOUR AU - Sluisveld, P.H. van AU - Zegers, M. AU - Westert, G.P. AU - Hoeven, J.G. van der AU - Wollersheim, H.C. PY - 2013 UR - https://hdl.handle.net/2066/118558 AB - BACKGROUND: To use intensive care unit (ICU) facilities efficiently and ensure high quality of care, an optimal patient flow is necessary. Discharging patients relieves the pressure on ICU beds but the risk of premature discharge must be managed carefully. Suboptimal patient discharge may result in ICU readmissions and in patients' death.The aim of this study is to obtain insight into the safety and efficiency of current ICU discharge practices and into barriers and facilitators to the implementation of effective ICU discharge interventions, and to develop an implementation strategy tailored to the barriers and facilitators identified. METHODS/DESIGN: This study exists of five phases. Phase A: analysis of routinely registered data on variation in ICU readmissions and hospital mortality after ICU discharge of all ICUs participating in the Dutch National Intensive Care Evaluation registry (n=83). Phase B: systematic review of effective interventions aiming to improve the efficiency and safety of the ICU discharge process. Phase C: assessing the intervention adherence with a questionnaire survey among all Dutch ICUs (n=90). Phase D: assessing barriers and facilitators to the implementation of effective ICU discharge interventions with a questionnaire survey among all Dutch intensivists (n=700). The questionnaire will be based on barriers and facilitators identified by focus groups (n=4) and individual interviews with professionals of ICUs and general wards and adult discharged ICU patients (n=25 to 30). Phase E: systematic development of an implementation strategy based on the sampled data in phase A to D, and effective implementation strategies from the literature using the intervention mapping method. DISCUSSION: Using theory and empirical data, an implementation strategy will be developed to improve the safety and efficiency of the ICU discharge process. The developed strategy will be evaluated in a subsequent study. The knowledge obtained in this study should be used for further implementation of ICU discharge interventions, and can be used for implementation of handover interventions in other healthcare transition settings. TI - A strategy to enhance the safety and efficiency of handovers of ICU patients: study protocol of the pICUp study EP - 67 SN - 1748-5908 SP - 67 JF - Implementation Science VL - vol. 8 L1 - https://repository.ubn.ru.nl/bitstream/handle/2066/118558/118558.pdf?sequence=1 ER -