Two-ICU pilot study identifies 11 core criteria for assessing readiness for discharge

A prospective before-after observational pilot study in two German intensive care units found that 11 of 28 proposed intensive care unit discharge criteria were completed in more than 80% of cases at the point of discharge decision. The findings support further evaluation of a shorter core set for routine discharge-readiness assessment, but the small cohorts and descriptive design did not establish effects on transfers, safety or patient outcomes.

The researchers implemented the criteria set, developed previously through a Delphi process, in a medical intensive care unit at a university hospital and an interdisciplinary intensive care unit at a teaching hospital. The study included adults who were discharged alive from intensive care to a lower-care setting. The two units had different discharge pathways, including general wards, intermediate or specialized wards, cardiology settings, and external long-term-care institutions.

Each phase lasted four weeks or one month at each site during 2022. During the baseline phase, researchers observed existing discharge-readiness workflows and assessed, without initially disclosing the proposed criteria set, which elements were already being used. During the implementation phase, the criteria were incorporated into routine work using either a patient data management system or a Microsoft Excel-based tool. Teams recorded each criterion as completed, not completed or not applicable. Considering the criteria during discharge decisions was intended, but adherence was not mandatory and the criteria did not determine patient status.

Implementation-phase adherence was assessed in 130 patient stays. At the point of discharge decision, 80 of 130 patients, or 62%, had all 28 criteria recorded as completed or not applicable. Eleven criteria met the study’s prespecified threshold of more than 80% completion at both sites and had no discharge-criterion-related reasons identified for the small number of readmissions. Nine of the 11 had already reached at least 80% completion when a patient was classified as a discharge option. No criterion crossed from above 80% completion at the discharge-option stage to below that threshold at the discharge-decision stage.

The proposed core set consisted mainly of patient-specific criteria, with some addressing the capabilities of the receiving unit. Six additional criteria were not applicable in more than 80% of stays at both sites, indicating that they were rarely relevant in the studied settings. Clinicians also reported that a 28-item list was too long for daily use and recommended clearer wording, grouping and a glossary. They supported local additions based on patient groups, care pathways and receiving-unit capabilities, as well as automatic reporting and an intuitive visual display integrated into routine documentation.

Patient-flow and safety-related measures were recorded descriptively. Median intensive care stay was 32.6 hours during baseline and 29.4 hours during implementation. Readmissions within 48 hours occurred in 3 of 117 patients, or 2.6%, during baseline and 4 of 130 patients, or 3.1%, during implementation. The study was not powered to test differences between phases, and the investigators said the observations did not provide a clear signal of improved readmission rates after implementation.

Discharge delays longer than two hours were reported for 68 of 117 stays, or 58%, during baseline and 84 of 130 stays, or 64.6%, during implementation. The accumulated delay was 792.5 hours during baseline and 628.4 hours during implementation. Capacity limitations at receiving units and other organizational difficulties were the principal reasons, rather than the readiness of individual patients. The investigators therefore could not determine whether implementing the criteria affected discharge timing. Urgent discharges also occurred in both phases, sometimes before every criterion had been completed, when capacity was constrained.

Scores intended to characterize patient acuity and nursing workload were available only for subsets of the cohort and were assessed descriptively. Their incomplete coverage and variable data quality prevented the researchers from drawing conclusions about associations with criteria completion or discharge readiness. The two implementation formats also were not compared in a way that could establish differences between digital-system and spreadsheet-based approaches.

The pilot provides feasibility evidence for a shorter, adaptable discharge-readiness framework, not proof of clinical benefit. Its limits included two sites, small local cohorts, short observation periods, missing data and differences between seasonal phases. Larger studies with longer follow-up, broader patient populations, mandatory adherence in some settings, and evaluation of receiving-unit capacity would be needed to determine whether standardized assessment affects timely transfers, readmissions or other safety outcomes.

Subject of Research: Feasibility of standardized ICU discharge-readiness criteria in a two-site German observational pilot study

Article Title: Implementation and feasibility evaluation of a standard set of intensive care unit discharge criteria in a prospective before-after observational pilot study

Article References: Hiller, M., Brugger, A., Nies, S., Schenk, A., Wittmann, M., Schütte, J.-K., Schröder, S., Riessen, R., Bracht, H., & Bakker, J. (2026). Implementation and feasibility evaluation of a standard set of intensive care unit discharge criteria in a prospective before-after observational pilot study. BMC Health Services Research, 26(1), Article 1323. https://doi.org/10.1186/s12913-026-15656-y

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15656-y

Keywords: intensive care, discharge readiness, clinical criteria, patient flow, readmissions, implementation study, observational pilot, care transitions, Implementation, feasibility, evaluation, standard