Designing a Process for Cardiology Patient Transfers: A Quality Improvement, Descriptive Study on Interprovider Communication and Resident Education

Abstract

Background: Patient transitions create vulnerability for care teams. Failures in the handoff process result in communication errors and knowledge gaps, mainly when the handoff occurs between resident and expert-level subspecialty clinicians. The authors set out to develop a standardized handoff using resident comfort as a proxy for implementation. The primary measurable aim of this study was to increase the percentage of pediatric residents who self-reported comfort in assuming care of patients transitioned from the cardiac intensive care unit to the cardiology acute care unit. Methods: Investigators surveyed residents at a 323-bed pediatric hospital on their handoff experiences. The study team performed a Failure Mode Effect Analysis and created a key driver diagram. Interventions included a transfer checklist and algorithm, a huddle between care teams, and education surrounding the transfer process. Results: Residents completed a survey before (n = 74) or after (n = 23) intervention. The percentage of residents who reported feeling “always” or “very often” prepared to care for patients at the time of transfer increased from 15% to 83%. The percentage of residents who reported that they “always” or “very often” had concerns about floor appropriateness decreased from 23% to 4%. Conclusions: The authors designed a transfer process to improve communication, resident-level education, and psychological safety among team members to ensure safe, thorough handoffs between providers with different levels of training. Although we cannot definitively conclude that resident comfort improved due to a small “n” postintervention, we offer a description outlining process changes, barriers to implementation, and lessons learned.

Comprehensive Improvement of Cardiology Inpatient Transfers: A Bed-availability Triggered Approach

“…18 Improvements in patient flow and provider satisfaction with handoff initiatives have been published in similar patient populations, but in lower volume environments. 14,30 Our project corroborates that these processes are generalizable to high-volume centers, and may serve as a handoff model in other settings with similar ICU to acute care dyads.…”

ED‐DEL: Development of a change package and toolkit for delirium in the emergency department

“…The change process for this initiative is adapted from the IHI Breakthrough Series 19 and has proven effective for the implementation of prior quality improvement initiatives. 20,22,23 The Change Package provides a step-by-step process to guide staff in setting up an ED delirium program, from selecting a team to spearhead the initiative to regularly testing and refining the program for continued success. The Toolkit accompanying the Change Package was created to provide resources to assist with implementing each step of the process and can be readily adapted to meet an ED's specific needs and considerations.…”