Introduction

Discharge is not a single event, but a process that involves careful planning and the involvement of medical, nursing and ancillary staff in a multidisciplinary team. Critical care represents only one part of the patient pathway from surgery to recovery and successful discharge is achieved when this continuum of care is acknowledged and appropriate planning for the next step is undertaken. Safe and timely discharge from the critical care unit after surgery can have a major impact on patient outcomes with failure to plan adequately leading to increased mortality and high rates of readmission.

It is important to recognize that discharge criteria are not simply the inverse of admission criteria and they must reflect the resources of the next level of care, staff skill levels and institutional guidelines. Critical care pathways and protocols can clarify expected progression for individual cases and aid discharge planning, which should commence at or before the time of admission.

Discharge planning

The move from the critical care unit to the next point of care is a key transition for patients after cardiothoracic surgery. The process of discharge planning is dynamic, multidisciplinary, goal directed and promotes continuity of care. The discharge plan is the mechanism that facilitates a patient's progression through the intensive care unit to the next level of care and beyond.

In addition to the medical needs of the patient, there are several factors to consider.