Reducing unnecessary delays during the transfer of patients from the paediatric intensive care unit to the general ward: a quality improvement project

Abstract

IntroductionDelaying the discharge of paediatric intensive care unit (PICU) patients is directly proportional to increased occupancy rate and cost. We aimed to study the process of transferring patients from the PICU to the general ward in order to improve the timeliness of this process while guaranteeing patient safety.MethodsA multidisciplinary quality improvement (QI) team was formed to analyse the transfer process. Several Plan Do Study Act cycles were tested, targeting all steps of the transfer process, and applying turnaround time (TAT)—the duration from the time of clinical transfer decision until the physical transfer of the patient—as an outcome measure, aiming for a TAT of 4 hours.ResultsBaseline results showed that medical transfer decisions by PICU attending physicians were taken late for most patients: only 19% of decisions were made by 08:00 by the on-call team. Average TAT of the transfer process was over 7 hours, with duration ranging from 7 to 17 hours. After implementing all suggested improvement interventions, early decision compliance improved to 59%. TAT improved gradually, starting in January 2017, until it approached our target (284–261 min≈4 hours) in February–May 2017.ConclusionPICU patient transfer process delays can be reduced by early evaluation, timely team communication and proper preparation. It is recommended that all personnel with early involvement avoid unnecessary delays by paying more attention to all process steps, starting with the clinical decision, until the physical transfer. Standardising transfer processes might lead to a decrease in the length of PICU stay, which is a desirable outcome, but this observation needs further exploration.

Improving ICU transitional care by combining quality management and nursing science – two scientific fields meet in a systematic literature review

“…Kauppi et al (2018) described that nurses did not feel that the hospital management understood the conditions in the general wards and that they thought more about staff numbers than about competence (Enger and Andershed, 2018). To direct the process and keep on track, it is necessary to have official management support through approved policies, memos or guidelines (Alali et al, 2019). Hoffman et al (2017) concluded that the role of effective leadership and senior level support in ICU transitional care could not be underestimated.…”

“…Standardizing the patient transfer process is often discussed as a way of improving the patient transfer process (Alali et al, 2019;Halvorson et al, 2016). Lee et al (2019) presented a Improving ICU transitional care queuing network model to study patient transitions.…”

“…de Grood et al (2018 concluded that IJQSS 12,3 multiprofessional team huddles with ICU and hospital ward teams and handoff at bedside are suggestions to improve transfers from ICU to general ward. In addition, Alali et al (2019) emphasized active involvement of the entire team when discharging patients, but that more exploration was needed. In a study by Pottenger et al (2016), the authors concluded that Comprehensive Unit-based Safety Program teams might improve patient safety, performance on external measures, patient experience, and value.…”

“…Improving the ICU discharge process deserves more attention from management (van Sluisveld et al, 2017) and a deeper understanding of the conditions in the wards is needed (Kauppi et al, 2018). According to Alali et al (2019), it is necessary to have official management support through approved policies or guidelines when directing the process and keeping on track. Therefore, it was IJQSS 12,3 slightly surprising that the core value "committed leadership" did not get more attention in the reviewed articles.…”

Improving physician handover documentation process for patient transfer from paediatric intensive care unit to general ward

“…Mandating the developed form as an essential requirement in EMR before shifting patients from the PICU and empowering nurses to hold the transfer if the handover was not documented, enhanced the improvement effect and applied pressure on PICU primary physicians to complete the transfer handover document. Knowing that PICU patient transfer process involved several steps (eg, clinical evaluation and decision making, communication with the receiving team, bed allocation, and patient and family preparedness), 13 we assumed that adding another step of handover documentation to the EMR after a complicated course in the critical care unit would be an extra burden to PICU residents or fellows already loaded with heavy and stressful rotations. However, survey results highlighted an increased satisfaction with available documented information during the handover process.…”