A multi-center prospective cohort study of patient transfers from the intensive care unit to the hospital ward
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To provide a 360-degree description of ICU-to-ward transfers.
Prospective cohort study of 451 adults transferred from a medical–surgical ICU to a hospital ward in 10 Canadian hospitals July 2014–January 2016. Transfer processes documented in the medical record. Patient (or delegate) and provider (ICU/ward physician/nurse) perspectives solicited by survey 24–72 h after transfer.
Medical records (100%) and survey responses (ICU physicians–80%, ICU nurses–80%, ward physicians–46%, ward nurses–64%, patients–74%) were available for most transfers. The median time from initiation to completion of transfer was 25 h (IQR 6–52). ICU physicians and nurses reported communicating with counterparts via telephone (78 and 75%) when transfer was requested (82 and 24%) or accepted (31 and 59%) and providing more elements of clinical information than ward physicians (mean 4.7 vs. 3.9, p < 0.001) and nurses (5.0 vs. 4.4, p < 0.001) reported receiving. Patients were more likely to report satisfaction with the transfer when they received more information (OR 1.32, 95% CI 1.18–1.48), had their questions addressed (OR 3.96, 95% CI 1.33–11.84), met the ward physician prior to transfer (OR 4.61, 95% CI 2.90–7.33), and were assessed by a nurse within 1 h of ward arrival (OR 4.70, 95% CI 2.29–9.66). Recommendations for improvement included having a documented care plan travel with the patient (all stakeholders), standardized face-to-face handover (physicians), avoiding transfers at shift change (nurses) and informing patients about pending transfers in advance (patients).
ICU-to-ward transfers are characterized by failures of patient flow and communication; experienced differently by patients, ICU/ward physicians and nurses, with distinct suggestions for improvement.
KeywordsCritical care Patient handoff Continuity of patient care Patient transfer Communication
The study was supported by the Canadian Frailty Network (Grant Number CORE 2013-12A). HTS was supported by a Population Health Investigator Award from Alberta Innovates and an Embedded Clinician Researcher Award from the Canadian Institutes of Health Research. RAF was supported by a personnel award from the Heart and Stroke Foundation, Ontario Provincial Office. SMB was supported by a Canada Research Chair in Critical Care Nephrology. We thank Chaim Bell, Paul Boucher, Jamie Boyd, Denise Buchner, Chip Doig, Niall Ferguson, William Ghali, Nancy Marlett, Claudio Martin, Marie McAdams, Daniel Niven, Tom Noseworthy, Peter Oxland, Orla Smith, Sharon Straus, Deborah White, Dan Zuege, and David Zygun for their support in planning and executing this study.
Compliance with ethical standards
Conflicts of interest
Funding sources had no role in the design, conduct, or reporting of this study and we are unaware of any conflicts of interest.
- 1.Patient Safety Network (2016) Patient safety primers: handoffs and signouts. Agency for Healthcare Research and Quality, Rockville, MDGoogle Scholar
- 2.Institute of Medicine Committee on the Quality of Health Care in America (2001) Crossing the quality chasm: a new health system for the 21st century. National Academy Press, Washington, DCGoogle Scholar
- 4.Garrouste-Orgeas M, Timsit JF, Vesin A, Schwebel C, Arnodo P, Lefrant JY, Souweine B, Tabah A, Charpentier J, Gontier O, Fieux F, Mourvillier B, Troche G, Reignier J, Dumay MF, Azoulay E, Reignier B, Carlet J, Soufir L (2010) Selected medical errors in the intensive care unit: results of the IATROREF study: parts I and II. Am J Respir Crit Care Med 181:134–142CrossRefPubMedGoogle Scholar
- 6.Australian Commission on Safety and Quality in Healthcare (2005) Clinical handover and patient safety. Australian Commission on Safety and Quality in Healthcare, Sydney, NSWGoogle Scholar
- 8.National Transitions of Care Coalition (2008) Improving transitions of care. National Transitions of Care Coalition, Washington, DCGoogle Scholar
- 9.Chaboyer W, Kendall E, Kendall M, Foster M (2005) Transfer out of intensive care: a qualitative exploration of patient and family perceptions. Aust Crit Care 18:138–141, 143–145Google Scholar
- 14.Pronovost P, Vohr E (2010) Safe patients, smart hospitals: how one doctor’s checklist can help us change health care from the inside out. Hudson Street Press, New York, NYGoogle Scholar
- 22.Team RC (2015) R: a language and environment for statistical computing. R Foundation for Statistical Computing, ViennaGoogle Scholar
- 23.Bagshaw SM, Opgenorth D, Potestio M, Hastings SE, Hepp SL, Gilfoyle E, McKinlay D, Boucher P, Meier M, Parsons-Leigh J, Gibney RT, Zygun DA, Stelfox HT (2016) Healthcare provider perceptions of causes and consequences of ICU capacity strain in a large publicly funded integrated health region: a qualitative study. Crit Care Med 45:e347–e356CrossRefGoogle Scholar
- 24.Bisognano M (2016) So-called “flow failures” are disrespectful to patients. Institute for Healthcare Improvement, Cambridge, MAGoogle Scholar
- 25.Accident and emergency, The Economist Newspaper Ltd, London, pp 48–50, 10 Sept 2016. https://www.economist.com/news/britain/21706563-nhs-mess-reformers-believe-new-models-health-care-many-pioneered
- 29.Matthaeus-Kraemer CT, Thomas-Rueddel DO, Schwarzkopf D, Rueddel H, Poidinger B, Reinhart K, Bloos F (2016) Crossing the handover chasm: clinicians’ perceptions of barriers to the early detection and timely management of severe sepsis and septic shock. J Crit Care 36:85–91CrossRefPubMedGoogle Scholar
- 34.DeRienzo CM, Frush K, Barfield ME, Gopwani PR, Griffith BC, Jiang X, Mehta AI, Papavassiliou P, Rialon KL, Stephany AM, Zhang T, Andolsek KM, Duke University Health System Graduate Medical Education Patient S, Quality C (2012) Handoffs in the era of duty hours reform: a focused review and strategy to address changes in the Accreditation Council for Graduate Medical Education Common Program Requirements. Acad Med 87:403–410CrossRefPubMedGoogle Scholar