Improving Transitions of Care between the Intensive Care Unit and General Internal Medicine Ward. A Demonstration Study

Abstract

Background: In-hospital transfers such as from the intensive care unit (ICU) to the general internal medicine (GIM) ward place patients at risk of adverse events. A structured handover tool may improve transitions from the ICU to the GIM ward. Objective: To develop, implement, and evaluate a customized user-designed transfer tool to improve transitions from the ICU to the GIM ward. Methods: This was a pre–post intervention study at a tertiary academic hospital. We developed and implemented a user-designed, structured, handwritten ICU-to-GIM transfer tool. The tool included active medical issues, functional status, medications and medication changes, consulting services, code status, and emergency contact information. Transfer tool users included GIM physicians, ICU physicians, and critical care rapid response team nurses. An implementation audit and mixed qualitative and quantitative analysis of pre–post survey responses was used to evaluate clinician satisfaction and the perceived quality of patient transfers. Results: The pre–post survey response rate was 51.8% (99/191). Respondents included GIM residents (58.5%), ICU rapid response team physicians and nurses (24.2%), and GIM attending physicians (17.2%). Less than half of clinicians (48.8%) reported that the preintervention transfer process was adequate. Clinicians who used the transfer tool reported that the transfer process was improved (93.3% vs. 48.8%, P = 0.03). Clinician-reported understanding of medication changes in the ICU increased (69.2% vs. 29.1%, P = 0.004), as did their ability to plan for a safe hospital discharge (69.2% vs. 31.0%, P = 0.01). However, only 64.2% of audited transfers used the tool. Frequently omitted sections included home medications (missing in 83.4% of audits), new medications (33.3%), and secondary diagnosis (33.3%). Thematic analysis of free-text responses identified areas for improvement including clarifying the course of ICU events and enhancing tool usability. Conclusion: A user-designed, structured, handwritten transfer tool may improve the perceived quality of patient transfers from the ICU to the GIM wards.

Impact of customised ICU handover protocol on the quality of ICU discharge reports

“…In another study related to discharge from the ICU to the internal medicine ward in Canada, Bodley et al 10 reported a higher percentage of doctors’ responses evaluating the information transfer process as ‘adequate’ (48.8% in the preintervention phase vs 93.3% in the postintervention phase, p=0.03). In this same investigation, the doctors reported a better understanding of medication use (29.1% preintervention vs 69.0% postintervention, p<0.01), a higher prevalence of adequate information for possible discharge home (31.0% preintervention vs 69.2% postintervention, p=0.01) and easier identification of which consulting services were involved in the patient’s care (38.8% preintervention vs 76.9% postintervention, p=0.01).…”

Adverse events experienced with intrahospital transfer of critically ill patients

“…[ 10 ] A similar finding was noted when a customized transfer tool was implemented to improve transitions from the ICU to the ward where half of the clinicians reported that the preintervention transfer process was satisfactory and it has been found that the implemented transfer tool significantly improved the transfer process (93.3% vs 48.8%, P = .03). [ 11 ]…”

Impacto da implementação de um protocolo sistematizado de transferência de informações na qualidade dos relatórios de alta da UTI em pacientes submetidos à cirurgia de revascularização miocárdica

“…Desta forma, nós utilizamos uma amostra de conveniência determinada pelo tempo de seguimento de 12 meses na fase pré-intervenção. Estudos internacionais do tipo pré e pós-intervenção sobre esse tema incluíram 50 -100 pacientes em cada fase estudada (Sheth et al, 2016;Bodley, 2020). A apresentação dos resultados dos 168 pacientes encontra-se a seguir.…”

“…(p = 0,03) e, no processo de transferência, em geral, de 3% para 24% (p < 0,01). Em outro estudo relacionado à alta da UTI, para a enfermaria de medicina interna no Canadá, Bodley et al (2020) demonstraram maior prevalência de respostas consideradas adequadas sobre o processo de transferência de informações após implementação do protocolo (48,8% na fase pré-intervenção versus 93,3% na fase pós-intervenção; p = 0,03). Nesta mesma investigação, também foi observada melhor compreensão sobre uso de medicamentos (29,1% na fase pré-intervenção versus 69,2% na fase pós-intervenção; p < 0,01), maior prevalência de informações adequadas para possível alta para casa (31,0% na fase pré-intervenção versus 69,2% na fase pós-intervenção; p = 0,01) e maior prevalência de fácil identificação de interconsultores (38,8% fase pré-intervenção versus 76,9% fase pós-intervenção; p = 0,01).…”

“…As taxas de resposta de médicos em formação encontrada na literatura são variáveis e dependentes da forma que o questionário é aplicado e variam de 26,6% a 100%, média 71,3% ± 19,5 (Phillips et al, 2017). Em estudo similar relacionado à transferência de informações pós-alta da UTI, na qual foi testada uma ferramenta sistematizada escrita, a taxa geral de respostas de questionário foi de 51,8% (Bodley et al, 2020).…”