Improving transitions in care from intensive care units: Development and pilot testing of an electronic communication tool for healthcare providers

Leigh, Jeanna Parsons; Brundin-Mather, Rebecca; Zjadewicz, Karolina; Soo, Andrea; Stelfox, Henry T.

doi:10.1016/j.jcrc.2020.01.019

Cited by 14 publications

(23 citation statements)

References 42 publications

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“…The literature searches identified 3153 references, after removal of duplicates, abstract and title screening and then assessment of full-text eligibility, 17 studies were included (table 1). 13 14 47–61 The publications of Wohlt et al (before)62 and Hatch et al (after)59 were considered as a single study referenced as Hatch et al ,59 for the purposes of this systematic review. The PRISMA flow chart for study inclusion is shown figure 1.…”

Section: Resultsmentioning

confidence: 99%

“…Most of the studies (76%) were from North America (n=12 the USA, n=1 Canada),47–53 55–60 three from Europe (n=2 The Netherlands, n=1 Belgium),13 14 61 and one from Australia54 (table 1). Only the study by Heselmans et al 14 was an RCT, 15 were uncontrolled before-after studies13 47–49 51–61 and one was an uncontrolled interrupted time-series analyses 50. Most studies (n=14, 82%) were conducted in single centres, three were multicentre studies 13 14 54.…”

Section: Resultsmentioning

confidence: 99%

“…Nine (53%) of the studies examined a single intervention component (table 1 and online supplemental table S1). 14 47–50 52 55 56 61 The key intervention components described were education of staff, medication review, guidelines, electronic transfer/hand-over checklist or letter and medicines reconciliation. Multicomponent interventions,51 53 54 57–59 targeted inappropriate medication continuation at transfer points.…”

Section: Resultsmentioning

confidence: 99%

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Medication-related interventions to improve medication safety and patient outcomes on transition from adult intensive care settings: a systematic review and meta-analysis

et al. 2022

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BackgroundPatients recovering from an episode in an intensive care unit (ICU) frequently experience medication errors on transition to the hospital ward. Structured handover recommendations often underestimate the challenges and complexity of ICU patient transitions. For adult ICU patients transitioning to a hospital ward, it is currently unclear what interventions reduce the risks of medication errors.The aims were to examine the impact of medication-related interventions on medication and patient outcomes on transition from adult ICU settings and identify barriers and facilitators to implementation.MethodsThe systematic review protocol was preregistered on PROSPERO. Six electronic databases were searched until October 2020 for controlled and uncontrolled study designs that reported medication-related (ie, de-prescribing; medication errors) or patient-related outcomes (ie, mortality; length of stay). Risk of bias (RoB) assessment used V.2.0 and ROBINS-I Cochrane tools. Where feasible, random-effects meta-analysis was used for pooling the OR across studies. The quality of evidence was assessed by Grading of Recommendations, Assessment, Development and Evaluations.ResultsSeventeen studies were eligible, 15 (88%) were uncontrolled before-after studies. The intervention components included education of staff (n=8 studies), medication review (n=7), guidelines (n=6), electronic transfer/handover tool or letter (n=4) and medicines reconciliation (n=4). Overall, pooled analysis of all interventions reduced risk of inappropriate medication continuation at ICU discharge (OR=0.45 (95% CI 0.31 to 0.63), I2=55%, n=9) and hospital discharge (OR=0.39 (95% CI 0.2 to 0.76), I2=75%, n=9). Multicomponent interventions, based on education of staff and guidelines, demonstrated no significant difference in inappropriate medication continuation at the ICU discharge point (OR 0.5 (95% CI 0.22 to 1.11), I2=62%, n=4), but were very effective in increasing de-prescribing outcomes on hospital discharge (OR 0.26 (95% CI 0.13 to 0.55), I2=67%, n=6)). Facilitators to intervention delivery included ICU clinical pharmacist availability and participation in multiprofessional ward rounds, while barriers included increased workload associated with the discharge intervention process.ConclusionsMulticomponent interventions based on education of staff and guidelines were effective at achieving almost four times more de-prescribing of inappropriate medication by the time of patient hospital discharge. Based on the findings, practice and policy recommendations are made and guidance is provided on the need for, and design of theory informed interventions in this area, including the requirement for process and economic evaluations.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Medication-related interventions to improve medication safety and patient outcomes on transition from adult intensive care settings: a systematic review and meta-analysis

et al. 2022

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“…Healthcare providers recognize that successful transitions in care require effective multi-disciplinary communication, comprehensive planning, and shared accountability throughout the entire transition process [ 15 ]. Poor management of the transition process has negative effects on the patient’s transition, health, treatment goals, and outcomes, and increases problems such as prolonged hospital stay, high cost of care, greater degree of disability, and psychological stress for the patient and family, and ultimately unavoidable death.…”

Section: Introductionmentioning

confidence: 99%

Challenges of the patient transition process from the intensive care unit: a qualitative study

et al. 2021

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Background:The transition of patients from the intensive care unit (ICU) to the general ward is challenging. Patients and caregivers experience high levels of anxiety during the transition period.This study aimed to explain the challenges that patients face during the transition process. Methods:In this qualitative research of conventional content analysis, data collection was conducted between February 2018 and July 2019 in educational hospitals affiliated with the Iran University of Medical Sciences. After obtaining informed consent, purposive sampling was performed with 22 nurses, intensive care physicians, anesthesiologists, and patients and their families using in-depth semi-structured interviews until data saturation. Results:The data obtained from the interviews indicated their perceptions and experiences, which are expressed scientifically through qualitative research. A total of 504 initial codes were extracted from continuous data analysis. The content analysis yielded three main themes in the challenges patients face during the transition process from the ICU: mixed feelings regarding transition (happiness/hope, worry/uncertainty, abandonment); care break (different atmosphere, the difference between the program and the quality of care, assigning care to the patient and family, and care culture and beliefs); and search for support and information (ineffective communication, self-care capacity of patient and family, ineffective and disrupted training, and weak follow-up programs), which inflicts care shock in the patients. Conclusions:The results showed that patients and their families were in a state of care shock during the ICU transition process and were sometimes disconcerted. It is necessary to design and implement care models according to the needs and challenges patients face during the transition period from ICU (patient-centered), based on the evidence available, and after considering the field of medicine and the accessibility of care in the country. The transition process can be improved and enhanced by obtaining knowledge about ICU transition care and related challenges as well as organizing a learning environment.

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“…Patients transferring from an intensive care unit (ICU) to a general ward are particularly vulnerable to preventable harm due to the high volume of complex information to be communicated toward staff and the transition to reduced monitoring [22]. Transitions in patient care are characterized by the movement of people and information between healthcare providers and care settings [23]. Cumulatively, these changes in environment, care, relationships, information and independence have been reported to place patients and their families at risk of transfer anxiety or relocation stress [24].…”

Section: Critical Points and Events Disturb Normal Life Passage Of Cmentioning

confidence: 99%

The Transition in Intensive Care Unit Patients: A Concept Analysis

Ghorbanzadeh

Ebadi

Hosseini

et al. 2020

Preprint

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Background: Transition in the health system is associated with the movement of the patient between clinical units and between hospitals, This is a complex process with several potential challenges including medical errors, adverse events, increased costs and patient dissatisfaction. Evidence shows that there is a need for greater clarity regarding the concept of transition. Objectives: The present Study was conducted to clarify the core elements of transition in patients admitted to the ICU.Methods: Walker and Avant's eight-step model was used to guide this concept analysis to provid a comprehensive definition of transition. A Literature search was conducted on CINAHL, Scopus, Pubmed, and Google scholar using the following keywords: transition, intensive care unit, transition care, patient transfer and transition process. Thus, after an extensive review of resources published in the years 2000-2020, articles related to this concept were examined based on the inclusion criteria. Definitions, properties, applications, consequences and empirical references of the concept of transition were extracted.Results: Transition is a complex, multifaceted concept with defining attributes: Critical points and events, disturb normal life, passage of change, instability and un-anticipated changes, Multiple needs, Inadequate continuity of care, Poor coordination of care and communication among health care providers, patients and families, multiple factor, multiple professionals, Awareness, Engagement And Adaptation. The differences in the response to transition according to the patient's condition or position (beliefs, attitudes, socioeconomic status, willingness and knowledge) and environmental conditions (the status of communication and support from the community) lead to the development of confidence, adaptation, recovery from critical illness and return to normal life or disability and other complications.Conclusion: The transition is a process of progressive change and the adaptation requires training and environmental changes to improve and develop new skills for transition. Nurses play a supportive and complementary role in successful transition of patients. Therefore, studies need to focuse on the evaluation of nurses' perceptions of patient transition and the consequences and outcomes. The result of this study provide a definition of transition that is relevant and useful for clinical research and practice in healthcare setting.

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Improving transitions in care from intensive care units: Development and pilot testing of an electronic communication tool for healthcare providers

Cited by 14 publications

References 42 publications

Medication-related interventions to improve medication safety and patient outcomes on transition from adult intensive care settings: a systematic review and meta-analysis

Medication-related interventions to improve medication safety and patient outcomes on transition from adult intensive care settings: a systematic review and meta-analysis

Challenges of the patient transition process from the intensive care unit: a qualitative study

The Transition in Intensive Care Unit Patients: A Concept Analysis

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