{"id":2968,"date":"2025-07-25T15:25:42","date_gmt":"2025-07-25T14:25:42","guid":{"rendered":"https:\/\/blogs.bmj.com\/ebn\/?p=2968"},"modified":"2025-07-25T16:17:28","modified_gmt":"2025-07-25T15:17:28","slug":"understanding-the-discharge-process-in-paediatric-intensive-care","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/ebn\/2025\/07\/25\/understanding-the-discharge-process-in-paediatric-intensive-care\/","title":{"rendered":"Understanding the discharge process in Paediatric Intensive Care"},"content":{"rendered":"

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Understanding the discharge process in PICU: Highlights from an Undergraduate Clinical Research Internship at Bristol Royal Hospital for Children<\/strong><\/p>\n

This week\u2019s blog is written by Ella Venn, who is a staff nurse on the Intensive Care Unit at North Bristol NHS Trust.<\/span><\/p>\n

Last summer I had the opportunity to take part in a clinical research internship<\/a> funded by the National Institute for Health and Care Research (NIHR) at Bristol Royal Hospital for Children (BRHC) part of University Hospitals Bristol and Weston NHS Foundation Trust<\/span>. The scheme provided first-hand exposure to real-world healthcare research as an undergraduate, and equipped me with valuable skills in data collection, handling, and analysis, while offering insight into the role of the clinical nurse researcher.<\/p>\n

To address the issue of delayed discharges from the Paediatric Intensive Care Unit (PICU) (1), myself and my fellow intern had the opportunity to carry out a small-scale project, contributing to the early stages of a larger, ongoing quality-improvement initiative. Our project consisted of two main components, the first being an observational study to better understand the current discharge process.<\/p>\n

With support from senior staff and our supervisors Dr Julie Menzies and Helen Pluess-Hall @jmenzies1 @HellsPH the second part of the project was to capture the process of discharge using a purpose-designed data collection tool. This tool allowed us to observe 10 discharges in real-time, recording activities according to three key categories: patient factors, paperwork and communication. These included specific events such as the time of consultant decision to discharge, verbal handover to the receiving ward, and bed confirmation by the site manager. We also annotated any further activities that arose including delays or barriers and any changes or omissions.<\/p>\n

The collected data then allowed us to calculate the total duration of discharge and generate metrics such as the average time for any given documented activity. In addition we represented the discharges visually by creating process maps (2) which were analysed to provide insights into factors such as the average number of interactions per discharge and the frequency of non-value activities.<\/p>\n

To complement the process mapping, we conducted mini semi-structured interviews with nursing staff. Using an Appreciative Inquiry framework (see: The Centre for Appreciative Inquiry, 2025<\/a>), we developed questions aimed at exploring staff insights on when the discharge process goes \u2018well\u2019.\u00a0 This provided insights on aspects that contribute to quality, safety, patient experience and efficiency.<\/span><\/p>\n

To conclude the internship, we presented our findings to an audience of healthcare professionals and researchers via an in-person presentation. Overall, our project indicated that discharges from the PICU are highly complex and non-sequential. Our initial recommendations focused on improving the consistency of pre-planning and addressing issues related to digital accessibility. While further recommendations were made to continue this project, we also highlighted several limitations within both components of our study that should be addressed moving forward.<\/p>\n

Alongside the main project, I completed a clinical shift in the Paediatric Intensive Care Unit (PICU), working with a bedside nurse caring for a patient enrolled in an interventional trial. We also participated in a series of mini-lectures led by our supervisors, which covered key topics such as consent and patient and public involvement and engagement (PPIE), illustrated with real-world examples from within the Trust. To conclude the internship, I had the opportunity to attend the national Paediatric Critical Care Society<\/a> (PCCS) Conference, which provided valuable context for both the work we had been involved in and wider research taking place nationally.<\/p>\n

Overall, I gained:<\/p>\n