Three major problems related to the discharge process
were identified. The first was a lack of effective discharge
coordination, with ward staff lacking awareness of the imminent
discharge. This was linked to the second problem,
which revolved around interruptions in the chain of verbal
and written communication between ICU and ward nurses.
ICU nurses gave extensive telephone handovers prior to
patient discharges, but this verbal report was provided to
Charge Nurses on the wards, whose main focus was on bed
and staff allocation. They did not record or share a lot of
this information with the ward nurse who was assigned to
care for the patient. A further disruption in communication
often occurred when ICU nurses physically delivered
the patient to the ward. If the relevant ward nurse was not
available, face-to-face handover did not occur. The central
problem was that information transfer occurred at the
point of coordination rather than the point of care, with
Charge Nurses given toomuch information, and the nurses
who were to care for the patients not receiving enough.