PhD defence M. (Maike) Hiller

Below is a brief summary of the dissertation:

This thesis examines a growing problem in hospitals: valuable intensive care (IC) beds are being used longer than necessary, while an ageing population with multiple health issues increasingly needs timely access to this highly specialized care. The research aimed to develop a framework that helps hospitals use IC capacity more efficiently by improving how and when patients are transferred from the IC to the next level of care.

A survey of current IC discharge practices showed that delayed transfers are the main cause of wasted IC capacity. These delays often stem from poorly aligned admission and transfer processes, overestimation of available care capacity on regular wards, and the lack of a structured, standardized way to assess whether a patient is ready to leave the IC.

A review of scientific literature revealed a major knowledge gap: no comprehensive, formal criteria existed to determine both a patient’s readiness for discharge and the receiving ward’s ability to provide appropriate care. To address this, the researchers developed a checklist of IC discharge criteria. An international panel of 27 IC experts refined this list through a five‑round Delphi process, resulting in 28 criteria. These were then tested in clinical practice, leading to a core set of 11 essential criteria, adaptable to different patient groups.

The thesis also proposes guidelines for improving care processes and managing change across hospital departments. Experiences during the COVID‑19 pandemic showed that better patient‑flow management and cross‑sector collaboration are achievable even under extreme pressure, offering inspiration for sustainable improvements in everyday care.