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Lyons PG, Rojas JC, Bewley AF, Malone SM, Santhosh L. Validating the Physician Documentation Quality Instrument for Intensive Care Unit-Ward Transfer Notes. ATS Sch 2024; 5:274-285. [PMID: 39055332 PMCID: PMC11270237 DOI: 10.34197/ats-scholar.2023-0094oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 01/09/2024] [Indexed: 07/27/2024] Open
Abstract
Background Physician communication failures during transfers of patients from the intensive care unit (ICU) to the general ward are common and can lead to adverse events. Efforts to improve written handoffs during these transfers are increasingly prominent, but no instruments have been developed to assess the quality of physician ICU-ward transfer notes. Objective To collect validity evidence for the modified nine-item Physician Documentation Quality Instrument (mPDQI-9) for assessing ICU-ward transfer note usefulness across several hospitals. Methods Twenty-four physician raters independently used the mPDQI-9 to grade 12 notes collected from three academic hospitals. A priori, we excluded the "up-to-date" and "accurate" domains, because these could not be assessed without giving the rater access to the complete patient chart. Assessments therefore used the domains "thorough," "useful," "organized," "comprehensible," "succinct," "synthesized," and "consistent." Raters scored each domain on a Likert scale ranging from 1 (low) to 5 (high). The total mPDQI-9 was the sum of these domain scores. The primary outcome was the raters' perceived clinical utility of the notes, and the primary measures of interest were criterion validity (Spearman's ρ) and interrater reliability (intraclass correlation [ICC]). Results Mean mPDQI-9 scores by note ranged from 19 (SD = 5.5) to 30 (SD = 4.2). Mean note ratings did not systematically differ by rater expertise (for interaction, P = 0.15). The proportion of raters perceiving each note as independently sufficient for patient care (the primary outcome) ranged from 33% to 100% across the set of notes. We found a moderately positive correlation between mPDQI-9 ratings and raters' overall assessments of each note's clinical utility (ρ = 0.48, P < 0.001). Interrater reliability was strong; the overall ICC was 0.89 (95% confidence interval [CI], 0.80-0.85), and ICCs were similar among reviewer groups. Finally, Cronbach's α was 0.87 (95% CI, 0.84-0.89), indicating good internal consistency. Conclusions We report moderate validity evidence for the mPDQI-9 to assess the usefulness of ICU-ward transfer notes written by internal medicine residents.
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Affiliation(s)
- Patrick G. Lyons
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, and
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon
| | - Juan C. Rojas
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Rush University, Chicago, Illinois
| | - Alice F. Bewley
- Division of Infectious Diseases, Department of Medicine, and
| | - Sara M. Malone
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri; and
| | - Lekshmi Santhosh
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California
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A Quality Improvement Project to Decrease Suboptimal Patient Transfers between Two Neonatal Units. Pediatr Qual Saf 2023; 8:e635. [PMID: 36798109 PMCID: PMC9925099 DOI: 10.1097/pq9.0000000000000635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 01/18/2023] [Indexed: 02/16/2023] Open
Abstract
Poorly executed transitions of care in health care systems are associated with safety concerns and patient dissatisfaction. We noticed several problems in the transfer process between our neonatal intensive care unit (NICU) and special care nursery (SCN) and designed this quality improvement project to address them. The aim was to decrease suboptimal transfers from the NICU to the SCN by 50% over 9 months. We defined suboptimal transfers as the discharge of a patient within 3 days of transfer from the NICU to the SCN or the return of a patient to the NICU within 5 days of the transfer. Methods We formed a multidisciplinary team and collected baseline data from October 2019 to December 2020. Major interventions included implementing a transfer checklist and algorithm. We utilized 3 staff surveys to evaluate the progress of the project. We used statistical process control charts to track project measures over time. Results Patient demographics and SCN length of stay were similar for the baseline and postintervention periods. We decreased suboptimal transfers over 21 months (January 2021 to September 2022), achieved a significantly increased rate of parent notification before transfers (81% baseline versus 93% postintervention), and increased staff satisfaction with the transfer process (15% baseline versus 43% postintervention). Conclusions We successfully improved the transfer process from our NICU to the SCN via a quality improvement project. Increased staff satisfaction and the lack of perception of additional burden to the staff from the new process are expected to sustain our results.
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Williams G, Pirret A, Credland N, Odell M, Raftery C, Smith D, Winterbottom F, Massey D. A practical approach to establishing a critical care outreach service: An expert panel research design. Aust Crit Care 2023; 36:151-158. [PMID: 35341667 DOI: 10.1016/j.aucc.2022.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 12/18/2021] [Accepted: 01/18/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND For over two decades, nurse-led critical care outreach services have improved the recognition, response, and management of deteriorating patients in general hospital wards, yet variation in terms, design, implementation, and evaluation of such services continue. For those establishing a critical care outreach service, these factors make the literature difficult to interpret and translate to the real-world setting. AIM The aim of this study was to provide a practical approach to establishing a critical care outreach service in the hospital setting. METHOD An international expert panel of clinicians, managers, and academics with experience in implementing, developing, operationalising, educating, and evaluating critical care outreach services collaborated to synthesise evidence, experience, and clinical judgment to develop a practical approach for those establishing a critical care outreach service. A rapid review of the literature identified publications relevant to the study. A modified Delphi technique was used to achieve expert panel consensus particularly in areas where insufficient published literature or ambiguities existed. FINDINGS There were 502 publications sourced from the rapid review, of which 104 were relevant and reviewed. Using the modified Delphi technique, the expert panel identified five key components needed to establish a critical care outreach service: (i) approaches to service delivery, (ii) education and training, (iii) organisational engagement, (iv) clinical governance, and (v) monitoring and evaluation. CONCLUSION An expert panel research design successfully synthesised evidence, experience, and clinical judgement to provide a practical approach for those establishing a critical care outreach service. This method of research will likely be valuable in other areas of practice where terms are used interchangeably, and the literature is diverse and lacking a single approach to practice.
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Affiliation(s)
- Ged Williams
- School of Nursing & Midwifery, Griffith University, Australia; South Metropolitan Health Service, Perth, Australia.
| | - Alison Pirret
- Critical Care Complex, Middlemore Hospital, Auckland, New Zealand; Massey University, Auckland, New Zealand
| | - Nicki Credland
- Reader in Critical Care Education, University of Hull, United Kingdom; Chair British Association of Critical Care Nurses (BACCN), United Kingdom
| | - Mandy Odell
- Critical Care, Royal Berkshire Hospital, NHS FT, Reading, United Kingdom
| | - Chris Raftery
- School of Nursing, Queensland University of Technology, Australia; Gold Coast Health, Queensland, Australia
| | - Duncan Smith
- City, University of London, Northampton Square, London, UK; Honorary Charge Nurse - Patient Emergency Response & Resuscitation Team, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | | | - Debbie Massey
- Southern Cross University, Australia; Intensive Care Unit John Flynn Hospital, Tugun, Australia
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A Multiple Baseline Trial of an Electronic ICU Discharge Summary Tool for Improving Quality of Care. Crit Care Med 2022; 50:1566-1576. [PMID: 35972243 DOI: 10.1097/ccm.0000000000005638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Effective communication between clinicians is essential for seamless discharge of patients between care settings. Yet, discharge summaries are commonly not available and incomplete. We implemented and evaluated a structured electronic health record-embedded electronic discharge (eDischarge) summary tool for patients discharged from the ICU to a hospital ward. DESIGN Multiple baseline trial with randomized and staggered implementation. SETTING Adult medical-surgical ICUs at four acute care hospitals serving a single Canadian city. PATIENTS Health records of patients 18 years old or older, in the ICU 24 hours or longer, and discharged from the ICU to an in-hospital patient ward between February 12, 2018, and June 30, 2019. INTERVENTION A structured electronic note (ICU eDischarge tool) with predefined fields (e.g., diagnosis) embedded in the hospital-wide electronic health information system. MEASUREMENTS AND MAIN RESULTS We compared the percent of timely (available at discharge) and complete (included goals of care designation, diagnosis, list of active issues, active medications) discharge summaries pre and post implementation using mixed effects logistic regression models. After implementing the ICU eDischarge tool, there was an immediate and sustained increase in the proportion of patients discharged from ICU with timely and complete discharge summaries from 10.8% (preimplementation period) to 71.1% (postimplementation period) (adjusted odds ratio, 32.43; 95% CI, 18.22-57.73). No significant changes were observed in rapid response activation, cardiopulmonary arrest, death in hospital, ICU readmission, and hospital length of stay following ICU discharge. Preventable (60.1 vs 5.7 per 1,000 d; p = 0.023), but not nonpreventable (27.3 vs 40.2 per 1,000d; p = 0.54), adverse events decreased post implementation. Clinicians perceived the eDischarge tool to produce a higher quality discharge process. CONCLUSIONS Implementation of an electronic tool was associated with more timely and complete discharge summaries for patients discharged from the ICU to a hospital ward.
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Ghorbanzadeh K, Ebadi A, Hosseini M, Maddah SSB, Khankeh H, Pishkhani MK, Adiban V. Factors Influencing the Decision-making of Healthcare Providers Regarding the Transition of Patients from the Intensive Care Unit to the General Ward in Iran: A Qualitative Study. Indian J Crit Care Med 2022; 26:568-573. [PMID: 35719458 PMCID: PMC9160623 DOI: 10.5005/jp-journals-10071-24211] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Kobra Ghorbanzadeh
- Department of Nursing, Khalkhal University of Medical Sciences, Khalkhal, Iran
| | - Abbas Ebadi
- Department of Behavioral Sciences Research Center, Lifestyle Institute, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mohammadali Hosseini
- Department of Nursing, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
- Mohammadali Hosseini, Department of Nursing, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran, Phone: +09121488457, e-mail:
| | | | - Hamidreza Khankeh
- Department of Nursing, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran; Department of Disaster and Emergency Medicine, Karolinska Institute, Stockholm, Sweden; Department of Clinical Science and Education, Karolinska Institute, Stockholm, Sweden
| | | | - Vahid Adiban
- Department of Anesthesiology, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
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Analysis and Improvement of Nursing Quality Based on Standardized Information Integration. JOURNAL OF HEALTHCARE ENGINEERING 2022. [DOI: 10.1155/2022/9172416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Information is becoming increasingly important in social development, and the medical industry’s informatization has made significant progress. This paper evaluates the role of nursing informatization in improving nursing quality management by analyzing and comparing changes in nursing quality before and after the implementation of nursing informatization. Using modern computer network technology to evaluate nursing quality, monitor the implementation of nursing management plans, and control nursing quality links in real time has helped to promote and improve nursing quality. The integration mode of the existing hospital information system is sorted out and standardized according to the requirements of refined hospital management. We can optimize the overall architecture of the hospital information system, reduce the tight coupling between business systems, support rapid integration and flexible expansion of business systems, and lay a foundation for the cooperation and data sharing of medical resources in and out of the hospital by establishing a hospital information platform based on standardized specifications.
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Kim E, Kast C, Afroz-Hossain A, Qiu M, Pappas K, Sinvani L. Bridging the Gap Between the Intensive Care Unit and the Acute Medical Care Unit. Am J Crit Care 2021; 30:193-200. [PMID: 34161979 DOI: 10.4037/ajcc2021591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Despite a growing cohort of intensive care unit (ICU) survivors, little is known about the early ICU aftercare period. OBJECTIVE To identify gaps in early ICU aftercare and factors associated with poor hospital outcomes. METHODS A multisite, retrospective study (January 1 to December 31, 2017) was conducted among randomly selected patients admitted to the medical ICU and subsequently transferred to acute medical care units. Records were reviewed for patient characteristics, ICU course, and early ICU aftercare practices and syndromes. Associations between practices and hospital outcomes were calculated with χ2 and Wilcoxon rank sum tests, followed by logistic regression. RESULTS One hundred fifty-one patients met inclusion criteria (mean [SD] age, 64.2 [19.1] years; 51.7% male; 44.4% White). The most frequent diagnoses were sepsis (35.8%) and respiratory failure (33.8%). During early ICU aftercare, 46.4% had dietary restrictions, 25.8% had bed rest orders, 25.0% had a bladder catheter, 26.5% had advance directive documentation, 33.8% had dysphagia, 34.3% had functional decline, and 23.2% had delirium. Higher Charlson Comorbidity Index (odds ratio, 1.6) and midodrine use on medical units (odds ratio, 7.5) were associated with in-hospital mortality; mechanical ventilation in the ICU was associated with rapid response on medical unit (odds ratio, 12.9); and bladder catheters were associated with ICU readmission (odds ratio, 5.2). CONCLUSIONS Delirium, debility, and dysphagia are frequently encountered in early ICU aftercare, yet bed rest, dietary restriction, and lack of advance directive documentation are common. Future studies are urgently needed to characterize and address early ICU aftercare.
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Affiliation(s)
- Eileen Kim
- Eileen Kim is assistant professor, Division of Hospital Medicine, Department of Medicine, Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York
| | - Charles Kast
- Charles Kast is assistant professor, Division of Hospital Medicine, Department of Medicine, Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York
| | - Anika Afroz-Hossain
- Anika Afroz-Hossain is assistant professor, Division of Hospital Medicine, Department of Medicine, Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York
| | - Michael Qiu
- Michael Qiu is a data analyst, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York
| | - Karalyn Pappas
- Karalyn Pappas is a biostatistician, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York
| | - Liron Sinvani
- Liron Sinvani is an associate professor, Division of Hospital Medicine, Department of Medicine, Zucker School of Medicine at Hofstra/Northwell, and an assistant professor, Feinstein Institutes for Medical Research, Northwell Health
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Parsons Leigh J, Brundin-Mather R, Whalen-Browne L, Kashyap D, Sauro K, Soo A, Petersen J, Taljaard M, Stelfox HT. Effectiveness of an Electronic Communication Tool on Transitions in Care From the Intensive Care Unit: Protocol for a Cluster-Specific Pre-Post Trial. JMIR Res Protoc 2021; 10:e18675. [PMID: 33416509 PMCID: PMC7822720 DOI: 10.2196/18675] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 11/16/2020] [Accepted: 11/17/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Transitions in care are vulnerable periods in health care that can expose patients to preventable errors due to incomplete or delayed communication between health care providers. Transitioning critically ill patients from intensive care units (ICUs) to other patient care units (PCUs) is particularly risky, due to the high acuity of the patients and the diversity of health care providers involved in their care. Instituting structured documentation to standardize written communication between health care providers during transitions has been identified as a promising means to reduce communication breakdowns. We developed an evidence-informed, computer-enabled, ICU-specific structured tool-an electronic transfer (e-transfer) tool-to facilitate and standardize the composition of written transfer summaries in the ICUs of one Canadian city. The tool consisted of 10 primary sections with a user interface combination of structured, automated, and free-text fields. OBJECTIVE Our overarching goal is to evaluate whether implementation of our e-transfer tool will improve the completeness and timeliness of transfer summaries and streamline communications between health care providers during high-risk transitions. METHODS This study is a cluster-specific pre-post trial, with randomized and staggered implementation of the e-transfer tool in four hospitals in Calgary, Alberta. Hospitals (ie, clusters) were allocated randomly to cross over every 2 months from control (ie, dictation only) to intervention (ie, e-transfer tool). Implementation at each site was facilitated with user education, point-of-care support, and audit and feedback. We will compare transfer summaries randomly sampled over 6 months postimplementation to summaries randomly sampled over 6 months preimplementation. The primary outcome will be a binary composite measure of the timeliness and completeness of transfer summaries. Secondary measures will include overall completeness, timeliness, and provider ratings of transfer summaries; hospital and ICU lengths of stay; and post-ICU patient outcomes, including ICU readmission, adverse events, cardiac arrest, rapid response team activation, and mortality. We will use descriptive statistics (ie, medians and means) to describe demographic characteristics. The primary outcome will be compared within each hospital pre- and postimplementation using separate logistic regression models for each hospital, with adjustment for patient characteristics. RESULTS Participating hospitals were cluster randomized to the intervention between July 2018 and January 2019. Preliminary extraction of ICU patient admission lists was completed in September 2019. We anticipate that evaluation data collection will be completed by early 2021, with first results ready for publication in spring or summer 2021. CONCLUSIONS This study will report the impact of implementing an evidence-informed, computer-enabled, ICU-specific structured transfer tool on communication and preventable medical errors among patients transferred from the ICU to other hospital care units. TRIAL REGISTRATION ClinicalTrials.gov NCT03590002; https://www.clinicaltrials.gov/ct2/show/NCT03590002. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/18675.
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Affiliation(s)
- Jeanna Parsons Leigh
- School of Health Administration, Faculty of Health, Dalhousie University, Halifax, NS, Canada.,Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Rebecca Brundin-Mather
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Liam Whalen-Browne
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Devika Kashyap
- Critical Care Medicine, Alberta Health Services, Calgary, AB, Canada
| | - Khara Sauro
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Oncology, Tom Baker Cancer Centre, Calgary, AB, Canada.,Arnie Charbonneau Cancer Institute, Health Research Innovation Centre, University of Calgary, Calgary, AB, Canada
| | - Andrea Soo
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Critical Care Medicine, Alberta Health Services, Calgary, AB, Canada
| | - Jennie Petersen
- Faculty of Applied Health Sciences, Brock University, St Catharines, ON, Canada
| | - Monica Taljaard
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Henry T Stelfox
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Critical Care Medicine, Alberta Health Services, Calgary, AB, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Improving ICU transitional care by combining quality management and nursing science – two scientific fields meet in a systematic literature review. INTERNATIONAL JOURNAL OF QUALITY AND SERVICE SCIENCES 2020. [DOI: 10.1108/ijqss-03-2020-0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this literature review was to explore to what extent quality management (QM) and nursing science offer complementary perspectives to provide better quality care, by looking at QM core concepts and tools.
Design/methodology/approach
A systematic literature review was conducted. Papers published in academic journals between January 2013 and December 2019 were included. A deductive content analysis was chosen using QM core values as an analytical framework.
Findings
The results showed that QM core values, methodologies and tools were found in the reviewed articles about intensive care unit (ICU) transitional care. The results indicated that core values in QM and the core competencies within nursing science in ICU transitional care are mutually dependent upon each other and exist as a whole. ICU transitional care is, however, a complex interpersonal process, characterized by differences in organizational cultures and core values and involving multidisciplinary teams that collaborate across hospital units. The QM core value that was least observed was committed leadership.
Research limitations/implications
Combining QM and nursing science can contribute to a deeper understanding of how to improve the ICU transitional care process by bringing complementary perspectives.
Practical implications
The included articles portray how QM is applied in ICU transitional care. Implications for future research focus on enhancing the understanding of how QM and nursing science can bring complementary perspectives in order to improve ICU transitional care and how QM values, methodologies and tools can be used in ICU transitional care. Committed leadership and team collaboration in ICU transitional care are areas that call for further research.
Originality/value
The findings contribute to the body of literature by providing important insights in terms of how QM core values, methodologies and tools are present in research about ICU transitional care and how the two research subjects, namely, QM and nursing science, bring complementary perspectives.
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10
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Hervé MEW, Zucatti PB, Lima MADDS. Transition of care at discharge from the Intensive Care Unit: a scoping review. Rev Lat Am Enfermagem 2020; 28:e3325. [PMID: 32696919 PMCID: PMC7365613 DOI: 10.1590/1518-8345.4008.3325] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 04/07/2020] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE to map the available evidence on the components of the transition of care, practices, strategies, and tools used in the discharge from the Intensive Care Unit (ICU) to the Inpatient Unit (IU) and its impact on the outcomes of adult patients. METHOD a scoping review using search strategies in six relevant health databases. RESULTS 37 articles were included, in which 30 practices, strategies or tools were identified for organizing and executing the transfer process, with positive or negative impacts, related to factors intrinsic to the Intensive Care Unit and the Inpatient Unit and cross-sectional factors regarding the staff. The analysis of hospital readmission and mortality outcomes was prevalent in the included studies, in which trends and potential protective actions for a successful care transition are found; however, they still lack more robust evidence and consensus in the literature. CONCLUSION transition of care components and practices were identified, in addition to factors intrinsic to the patient, associated with worse outcomes after discharge from the Intensive Care Unit. Discharges at night or on weekends were associated with increased rates of readmission and mortality; however, the association of other practices with the patient's outcome is still inconclusive.
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Abstract
Surviving a critical illness can have long-term effects on both patients and families. These effects can be physical, emotional, cognitive, and social, and they affect both the patient and the family. Family members play a key role in helping their loved one recover, and this recovery process can take considerable time. Transferring out of an intensive care unit, and discharging home from a hospital, are important milestones, but they represent only the beginning of recovery and healing after a critical illness. Recognizing that these challenges exist both for patients and families is important to improve critical illness outcomes.
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12
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Improving transitions in care from intensive care units: Development and pilot testing of an electronic communication tool for healthcare providers. J Crit Care 2020; 56:265-272. [DOI: 10.1016/j.jcrc.2020.01.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 12/08/2019] [Accepted: 01/16/2020] [Indexed: 11/23/2022]
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Boyd JM, Roberts DJ, Parsons Leigh J, Stelfox HT. Administrator Perspectives on ICU-to-Ward Transfers and Content Contained in Existing Transfer Tools: a Cross-sectional Survey. J Gen Intern Med 2018; 33:1738-1745. [PMID: 30051330 PMCID: PMC6153252 DOI: 10.1007/s11606-018-4590-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 04/20/2018] [Accepted: 07/10/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND The transfer of critically ill patients from the intensive care unit (ICU) to hospital ward is challenging. Shortcomings in the delivery of care for patients transferred from the ICU have been associated with higher healthcare costs and poor satisfaction with care. Little is known about how hospital ward providers, who accept care of these patients, perceive current transfer practices nor which aspects of transfer they perceive as needing improvement. OBJECTIVE To compare ICU and ward administrator perspectives regarding ICU-to-ward transfer practices and evaluate the content of transfer tools. DESIGN Cross-sectional survey design. PARTICIPANTS We administered a survey to 128 medical and/or surgical ICU and 256 ward administrators to obtain institutional perspectives on ICU transfer practices. We performed qualitative content analysis on ICU transfer tools received from respondents. KEY RESULTS In total, 108 (77%) ICU and 160 (63%) ward administrators responded to the survey. The ICU attending physician was reported to be "primarily responsible" for the safety (93% vs. 91%; p = 0.515) of patient transfers. ICU administrators more commonly perceived discharge summaries to be routinely included in patient transfers than ward administrators (81% vs. 60%; p = 0.006). Both groups identified information provided to patients/families, patient/family participation during transfer, and ICU-ward collaboration as opportunities for improvement. A minority of hospitals used ICU-to-ward transfer tools (11%) of which most (n = 21 unique) were designed to communicate patient information between providers (71%) and comprised six categories of information: demographics, patient clinical course, corrective aids, mobility at discharge, review of systems, and documentation of transfer procedures. CONCLUSION ICU and ward administrators have similar perspectives of transfer practices and identified patient/family engagement and communication as priorities for improvement. Key information categories exist.
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Affiliation(s)
- Jamie M Boyd
- Departments of Critical Care Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Derek J Roberts
- Department of Surgery, University of Calgary and the Foothills Medical Centre, Calgary, Alberta, Canada
| | - Jeanna Parsons Leigh
- Departments of Critical Care Medicine, O'Brien Institute for Public Health, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
| | - Henry Thomas Stelfox
- Departments of Critical Care Medicine, Medicine and Community Health Sciences, O'Brien Institute for Public Health, University of Calgary and Alberta Health Services - Calgary Zone, Calgary, Alberta, Canada.
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14
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Sirgo Rodríguez G, Chico Fernández M, Gordo Vidal F, García Arias M, Holanda Peña MS, Azcarate Ayerdi B, Bisbal Andrés E, Ferrándiz Sellés A, Lorente García PJ, García García M, Merino de Cos P, Allegue Gallego JM, García de Lorenzo Y Mateos A, Trenado Álvarez J, Rebollo Gómez P, Martín Delgado MC. Handover in Intensive Care. Med Intensiva 2018; 42:168-179. [PMID: 29426704 DOI: 10.1016/j.medin.2017.12.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 11/21/2017] [Accepted: 12/01/2017] [Indexed: 01/12/2023]
Abstract
Handover is a frequent and complex task that also implies the transfer of the responsibility of the care. The deficiencies in this process are associated with important gaps in clinical safety and also in patient and professional dissatisfaction, as well as increasing health cost. Efforts to standardize this process have increased in recent years, appearing numerous mnemonic tools. Despite this, local are heterogeneous and the level of training in this area is low. The purpose of this review is to highlight the importance of IT while providing a methodological structure that favors effective IT in ICU, reducing the risk associated with this process. Specifically, this document refers to the handover that is established during shift changes or nursing shifts, during the transfer of patients to other diagnostic and therapeutic areas, and to discharge from the ICU. Emergency situations and the potential participation of patients and relatives are also considered. Formulas for measuring quality are finally proposed and potential improvements are mentioned especially in the field of training.
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Affiliation(s)
- G Sirgo Rodríguez
- Servicio de Medicina Intensiva, Hospital Universitario Joan XXIII, Instituto de Investigación Sanitaria Pere Virgili, Tarragona, España
| | - M Chico Fernández
- UCI de Trauma y Emergencias (UCITE), Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, España
| | - F Gordo Vidal
- Servicio de Medicina Intensiva, Hospital Universitario del Henares, Madrid, España
| | - M García Arias
- Servicio de Medicina Intensiva, Hospital Universitario del Henares, Madrid, España
| | - M S Holanda Peña
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - B Azcarate Ayerdi
- Servicio de Medicina Intensiva, Hospital Universitario Donostia, San Sebastián, España
| | - E Bisbal Andrés
- Servicio de Medicina Intensiva, Hospital Universitario General de Castellón, Castellón, España
| | - A Ferrándiz Sellés
- Servicio de Medicina Intensiva, Hospital Universitario General de Castellón, Castellón, España
| | - P J Lorente García
- Servicio de Medicina Intensiva, Hospital Universitario General de Castellón, Castellón, España
| | - M García García
- Servicio de Medicina Intensiva, Hospital Universitario Río Hortega, Valladolid, España
| | - P Merino de Cos
- Servicio de Medicina Intensiva, Hospital Can Misses, Ibiza, España
| | - J M Allegue Gallego
- Servicio de Medicina Intensiva, Hospital Universitario Santa Lucía, Cartagena, España
| | | | - J Trenado Álvarez
- Servicio de Medicina Intensiva, Hospital de Terrassa, Terrassa, España
| | - P Rebollo Gómez
- Servicio de Medicina Intensiva, Hospital Universitario de Torrejón, Madrid
| | - M C Martín Delgado
- Servicio de Medicina Intensiva, Hospital Universitario de Torrejón, Madrid.
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Buchner DL, Bagshaw SM, Dodek P, Forster AJ, Fowler RA, Lamontagne F, Turgeon AF, Potestio M, Stelfox HT. Prospective cohort study protocol to describe the transfer of patients from intensive care units to hospital wards. BMJ Open 2015; 5:e007913. [PMID: 26155820 PMCID: PMC4499701 DOI: 10.1136/bmjopen-2015-007913] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 04/20/2015] [Accepted: 04/23/2015] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION The transfer of patient care between the intensive care unit (ICU) and the hospital ward is associated with increased risk of medical error and adverse events. This study will describe patient transfer from ICU to hospital ward by documenting (1) patient, family and provider experiences related to ICU transfer, (2) communication between stakeholders involved in ICU transfer, (3) adverse events that follow ICU transfer and (4) opportunities to improve ICU to hospital ward transfer. METHODS This is a mixed methods prospective observational study of ICU to hospital ward transfer practices in 10 ICUs across Canada. We will recruit 50 patients at each site (n=500) who are transferred from ICU to hospital ward, and distribute surveys to enrolled patients, family members, and healthcare providers (ICU and ward physicians and nurses) after patient transfer. A random sample of 6 consenting study participants (patients, family members, healthcare providers) from each study site (n=60) will be offered an opportunity to participate in interviews to further describe stakeholders' experience with ICU to hospital ward transfer. We will abstract information from patient health records to identify clinical data and use of transfer tools, and identify adverse events that are related to the transfer. ETHICS AND DISSEMINATION Research ethics board approval has been obtained at the coordinating study centre (UofC REB13-0021) and 5 study sites (UofA Pro00050646; UBC-PHC H14-01667; Sunnybrook 336-2014; QCH 14-07; Sherbrooke 14-172). Dissemination of the findings will provide a comprehensive description of transfer from ICU to hospital ward in Canada including the uptake of validated or local transfer tools, a conceptual framework of the experiences and needs of stakeholders in the ICU transfer process, a summary of adverse events experienced by patients after transfer from ICU to hospital ward, and opportunities to guide quality improvement efforts.
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Affiliation(s)
| | - Sean M Bagshaw
- Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Peter Dodek
- Division of Critical Care Medicine and Center for Health Evaluation and Outcome Sciences, St. Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Alan J Forster
- The Ottawa Hospital Research Institute, Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Robert A Fowler
- Department of Medicine, Department of Critical Care Medicine, Sunnybrook Hospital, University of Toronto, Toronto, Canada
| | - François Lamontagne
- Centre de Recherche du CHU de Sherbrooke, Universite de Sherbrooke, Sherbrooke, Canada
| | - Alexis F Turgeon
- Department of Anesthesiology and Critical Care Medicine, CHU de Quebec Research Center, Quebec City, Canada
| | - Melissa Potestio
- Critical Care Strategic Clinical Network, Alberta Health Services, Calgary, Canada
| | - Henry T Stelfox
- Department of Critical Care Medicine, University of Calgary, Calgary, Canada
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