Transición del cuidado al momento del alta de la Unidad de Cuidados Intensivos: una revisión sistemática exploratoria

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

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Brasil

Revista Latino-Americana de Enfermagem

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Brasil

Español English

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Sumário

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

Transición del cuidado al momento del alta de la Unidad de Cuidados Intensivos: una revisión sistemática exploratoria^* * Artículo parte de la disertación de maestria “Associação da Transição do Cuidado com Eventos Adversos após a Alta de um Centro de Terapia Intensiva”, presentada en la Universidade Federal do Rio Grande do Sul, Porto Alegre, RS. Apoyo financiero del Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Brasil, proceso nº 4339972018-4.

Autoría SCIMAGO INSTITUTIONS RANKINGS

Objetivo:

mapear la evidencia disponible sobre los componentes de la transición del cuidado, las prácticas, las estrategias y las herramientas que se utilizan al momento del alta de la Unidad de Cuidados Intensivos a la Unidad de Internación y su efecto sobre los resultados de pacientes adultos.

Método:

una revisión sistemática exploratoria en la que se emplean estrategias de búsqueda en seis bases de datos sobre salud relevantes.

Resultados:

se incluyeron 37 artículos, en los cuales se identificaron 30 prácticas, estrategias o herramientas para organizar y ejecutar el proceso de transferencia, con efectos positivos o negativos, relacionados con factores intrínsecos a la Unidad de Cuidados Intensivos y a la Unidad de Internación, además de factores transversales relacionados con el personal. El análisis de los resultados de reinternación y mortalidad fue prevalente en los estudios incluidos, en los cuales pueden encontrarse tendencias y acciones potencialmente protectoras para una transición de cuidados exitosa; sin embargo, siguen careciendo de evidencias y consenso más sólidos en la literatura.

Conclusión:

se identificaron componentes y las prácticas de la transición del cuidado, además de factores intrínsecos al paciente, asociados con peores resultados después del alta de la Unidad de Cuidados Intensivos. Las altas nocturnas o durante los fines de semana se asociaron con índices más elevados de reinternaciones y mortalidad; sin embargo, la asociación de otras prácticas con el resultado del paciente sigue sin ser concluyente.

Descriptores:
Cuidados Críticos; Unidades de Cuidados Intensivos; Transferencia de Pacientes; Continuidad de la Atención al Paciente; Alta del Paciente; Pase de Guardia

Base de datos	Estrategia	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)	Fecha de publicación: 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, año de publicación]
Web of Science	Topic: ((“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))	Años de publicación: (2018 OR 2017 OR 2016 OR 2015 OR 2014 OR 2013) AND Languages: (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	All 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 = Cantidad de artículo;	%^† † Porcentaje de artículos
País
Estados Unidos	8	21,6
Canadá	6	16,2
Australia	4	10,8
Australia/Nueva Zelanda	3	8,1
Suecia	3	8,1
Reino Unido	3	8,1
Países Bajos	2	5,4
Corea del Sur	2	5,4
Brasil	1	2,7
Argentina	1	2,7
Uruguay	1	2,7
Noruega	1	2,7
Bélgica	1	2,7
Estados Unidos, Canadá y Reino Unido	1	2,7
Tipo de estudio
Cuasi-experimental	7	18,9
Cohorte prospectivo	7	18,9
Cualitativo	7	18,9
Descriptivo	6	16,2
Cohorte retrospectivo	5	13,5
Combinado (cualitativo + descriptivo)	2	5,4
Validación clínica	1	2,7
Ensayo clínico aleatorizado	1	2,7
Ensayo clínico aleatorizado piloto	1	2,7
Año de publicación
2014	9	24,3
2015	7	18,9
2016	4	10,8
2017	8	21,6
2018	9	24,3

Prácticas, estrategias y herramientas con un posible efecto positivo o negativo en la transición de la Unidad de Cuidados Intensivos a la Unidad de Internación	Efecto
Factores relacionados con la Unidad de Cuidados Intensivos
Alta por la noche(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-... ), en los cambios 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-... ) y los fines 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
Comunicación inadecuada y/o no estandarizada de información clave(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 prematura(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
Ningún criterio para el 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
Demoras en la transferencia(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 de cuidados no definidas(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
Destino incorrecto después del 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... ,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
Entorno inadecuado para una comunicación 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
Comunicación 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... ) y 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... ) con el personal de la Unidad de Internación	Positivo
Monitoreo/Asesoramiento post-alta por parte de profesionales de la Unidad de Cuidados Intensivos(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
Planificación del alta y pautas de orientación para pacientes/familiares(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
Reconciliación/Revisión de medicamentos por parte del farmacéutico(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
Lista de verificación/Herramientas de transferencia/Protocolos para el 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
Planificación anticipada del alta(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
Participación del paciente y de la familia durante la transferencia(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
Utilización de herramientas/puntuaciones de estratificación del riesgo(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
Transferencia de los cuidados en la misma habitación(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
Optimización de signos vitales antes del alta y reducción de la necesidad 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 a unidades de cuidados intermedias(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 valorar el proceso de la transicióndel 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
Transferencia de los cuidados a sus respectivos colegas por parte de todos los integrantes del equipo multidisciplinario(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
Factores relacionados con la Unidad de Internación
Falta de calificación y experiencia en el personal (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
Menor capacidad de monitoreo(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
Menor cantidad de profesionales(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 materiales disponibles(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
Tiempo más prolongado hasta la primera evaluación clínica del 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
Fragmentación de los cuidados entre varios equipos(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
Contacto previo del equipo nuevo con el 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
Factores relacionados tanto con la Unidad de Cuidados Intensivos como con la Unidad de Internación
Responsabilidad por la información enviada y recibida(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 por riesgo de reinternación(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 de correspondencia: Michele Elisa Weschenfelder Hervé. E-mail: mweschenfelder@hcpa.edu.br