Departments of Critical Care Medicine, and Community Health Sciences, O'Brien Institute for Public Health, University of Calgary and Alberta Health Services, Calgary, Canada.
Department of Critical Care Medicine and Critical Care Strategic Clinical Network, University of Calgary and Alberta Health Services, Calgary, Canada.
Intensive Care Med. 2017 Oct;43(10):1485-1494. doi: 10.1007/s00134-017-4910-1. Epub 2017 Aug 29.
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.
全面描述 ICU 至病房的转科过程。
2014 年 7 月至 2016 年 1 月，对 10 家加拿大医院的 451 名成年患者从综合 ICU 转至病房进行前瞻性队列研究。在病历中记录转科过程。通过调查，在转科后 24-72 小时收集患者（或其代理人）和医护人员（ICU/病房医生/护士）的观点。
大多数转科均有病历（100%）和调查回复（ICU 医生-80%，ICU 护士-80%，病房医生-46%，病房护士-64%，患者-74%）。从开始到完成转科的中位时间为 25 小时（IQR 6-52）。当请求（82%）或接受（31%）转科时，ICU 医生和护士通过电话与对应科室沟通，并提供比病房医生（平均 4.7 对 3.9，p<0.001）和护士（5.0 对 4.4，p<0.001）更多的临床信息。当患者收到更多信息（OR 1.32，95%CI 1.18-1.48）、他们的问题得到解答（OR 3.96，95%CI 1.33-11.84）、在转科前见到病房医生（OR 4.61，95%CI 2.90-7.33）以及在到达病房后 1 小时内得到护士评估（OR 4.70，95%CI 2.29-9.66）时，更可能对转科感到满意。改进建议包括随患者携带书面护理计划、进行标准化的面对面交接（医生）、避免在换班时转科（护士）以及提前告知患者即将进行的转科（患者）。
ICU 至病房的转科过程以患者流程和沟通失败为特征；患者、ICU/病房医生和护士的体验不同，并有不同的改进建议。
