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.
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