Improving transitions of care between the Intensive Care Unit and General Internal Medicine Ward: A Demonstration Study
CCCF ePoster library. Bodley T. 11/13/19; 283403; EP130
Dr. Thomas Bodley
Dr. Thomas Bodley
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Abstract
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ePoster
Topic: Quality Assurance & Improvement

Bodley, Thomas1;  Rassos, James2; Mansoor, Wasim2;  Bell, Chaim M2; Detsky, Michael E1,2
1: Interdepartmental Division of Critical Care, University of Toronto, Toronto, Canada
2: Department of Medicine, University of Toronto, Toronto, Canada


Introduction:  In-hospital patient transfers, such as  between the intensive care unit (ICU) and general internal medicine (GIM) ward, place patients at risk of adverse events,1 medication errors,2,3 and are a source of patient and clinician dissatisfaction.4,5   

Objectives:  The purpose of this study was to design, implement, and evaluate a structured handover tool to improve transfers from the ICU to the GIM ward.

Methods:  We performed a pre-post intervention study with a user designed hand-written transfer tool to facilitate ICU transfers.  The tool included the patient's active medical issues, functional capacity, medication reconciliation, consultants involved in care, code status and emergency contact information.  Tool utilization and completeness were audited.  A mixed methods analysis of quantitative and qualitative pre/post survey responses was used to evaluate clinician satisfaction and the perceived quality of the transfer process.

Results:  The survey response rate was 52% (99/191); 59% (83/142) pre-intervention and 33% (16/39) post-intervention. Respondents included GIM Residents (59%), ICU team members (24%), and GIM physicians (17%).  Less than half of clinicians (48.8%) reported that the existing transfer process was adequate prior to handover tool implemented.  Clinicians who utilized the transfer tool reported that the transfer process was improved (93.3% vs 48.8%, p=0.03).  Clinicians' understanding of the reason for hospital admission increased (92.3% vs 62.8%, p=0.04), as well as the reason for medication changes (69.2% vs 29.1%, p=0.004).  However, only 64.2% of audited transfers used the transfer tool.  Sections of the transfer tool that were omitted included home medications (missing in 83.4% of audits), new medications (missing in 33.3%), and secondary diagnosis (missing in 33.3%).  Thematic analysis of free-text responses identified areas for handover tool improvement, including clarifying the course of events in the ICU and enhancing tool usability to facilitate completion.

Conclusion:  A user-designed, structured hand-written transfer tool can improve the perceived quality of patient transfers from the ICU to the GIM wards.  Reliable utilization of such tools will require careful design focusing on usability.
 


  1. Patient Safety Network - Agency for Health Care Research and Quality. Patient safety primers: handoffs and signouts. 2019 [cited July 5, 2019]. Available online: https://psnet.ahrq.gov/primers/primer/9/Handoffs-and-Signouts.
  2. Bell CM, Brener SS, Gunraj N, et al. Association of ICU or hospital admission with unintentional discontinuation of medications for chronic diseases. JAMA 2011;306:840-7.
  3. Cognet S and Coyer F. Discharge practices for the intensive care patient: a qualitative exploration in the general ward setting. Intensive Crit Care Nurs 2014;30(5):292-300.
  4. De Grood C, Parsons J, Bagshaw SM, et al. Patient, family and provider experiences with transfers from intensive care unit to hospital ward: a multicenter qualitative study. CMAJ 2018;190:E669-76.
  5. Stelfox HT, Lane D, Boyd JM, et al. A scoping review of patient discharge from intensive care: opportunities and tools to improve care. Chest 2015;147:317-27.
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