An Interprofessional and Patient-Centred Approach to Improving Transitions from Intensive Care Unit (ICU) to Ward
CCCF ePoster library. Michelle Au R. Nov 8, 2018; 233334
Rina-Marie Austrie-Fletcher and Michelle Au
Rina-Marie Austrie-Fletcher and  Michelle Au
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Abstract
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Introduction

Inadequately planned transfer of patients between ICU and the ward adversely impact patient/families and healthcare providers (HCPs). Patients/families report feelings of anxiety, fear, abandonment and loss of control. Similarly, HCPs on the receiving ward report increased stress due to concerns that they are unable to meet patient/family expectations and feel inadequately prepared to meet care needs.

Emerging evidence suggests breakdown in the flow of information between units can lead to patient safety incidents that result in readmission to ICU and patient harm, including death.  Patients may also undergo unnecessary tests and treatments leading to patient/family confusion related to perceived conflicting decision making by the health care team.

Objectives

NYGH ICU collaborated with the Medical/Stroke Unit (MSU) and the Patient and Family Advisory Committee to develop a standardized discharge protocol with the following goals:




  • improve communication among multidisciplinary HCPs

  • reduce medical errors associated with transitions

  • reduce anxiety of patients and families during transitions of care

  • improve staff and physician satisfaction



Methods

We created a standardized discharge workflow for patients with an ICU length of stay greater than 2 weeks who were discharged to the MSU. The primary outcome measure was patient/family and staff satisfaction. Secondary outcome measure was improvement of ward staff and General Internal Medicine (GIM) physicians’ satisfaction with the transition process. The components of the standardized workflow included: individualized care plan with input from patient/family and multidisciplinary team including nurse, respiratory therapist, dietitian, physician, social worker; providing patients/families with Critical Care Response Team (CCRT) business card indicating they can activate a CCRT consultation; an in-person warm handoff between ICU and ward; a dictated summary of the ICU experience by intensivist.   

A group session was conducted to gain feedback about current transition practices from ICU to ward. A pre-survey was developed for ward staff and GIM physicians based on research articles and identified gaps with the goal of closing these gaps. Pre-implementation satisfaction surveys were distributed to multidisciplinary HCPs assuming care upon transfer from ICU.  A post-implementation patient/family survey was developed based on their stories to receive feedback about transition from CrCU to ward.

Results

26 out of 95 (27%) ward staff completed the survey. Common themes were “unrealistic expectations” of patients/families such as nurse/patient ratio, frequency of rounding and monitoring; and inadequate information sharing to ward staff to provide care to complex patients.  9 out of 9 (100%) GIM physicians completed the survey and 100% of participants were dissatisfied with the current transition process. Since implementation, 5 out of 5 (100%) patients had a dictated intensivist summary, interprofessional warm hand-off, and individualized care plan. We do not have any baseline patient and family surveys; however, we are currently collecting post intervention/implementation surveys focused on transitions and overall experience.

Conclusion

Preliminary findings indicate that this QI initiative has resulted in improved communication and standardization of the transition process.  Future success measures will be achieving an increase in patient, family, staff and physician satisfaction.


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