Departments of Critical Care Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
Department of Surgery, University of Calgary and the Foothills Medical Centre, Calgary, Alberta, Canada.
J Gen Intern Med. 2018 Oct;33(10):1738-1745. doi: 10.1007/s11606-018-4590-8. Epub 2018 Jul 26.
The transfer of critically ill patients from the intensive care unit (ICU) to hospital ward is challenging. Shortcomings in the delivery of care for patients transferred from the ICU have been associated with higher healthcare costs and poor satisfaction with care. Little is known about how hospital ward providers, who accept care of these patients, perceive current transfer practices nor which aspects of transfer they perceive as needing improvement.
To compare ICU and ward administrator perspectives regarding ICU-to-ward transfer practices and evaluate the content of transfer tools.
Cross-sectional survey design.
We administered a survey to 128 medical and/or surgical ICU and 256 ward administrators to obtain institutional perspectives on ICU transfer practices. We performed qualitative content analysis on ICU transfer tools received from respondents.
In total, 108 (77%) ICU and 160 (63%) ward administrators responded to the survey. The ICU attending physician was reported to be "primarily responsible" for the safety (93% vs. 91%; p = 0.515) of patient transfers. ICU administrators more commonly perceived discharge summaries to be routinely included in patient transfers than ward administrators (81% vs. 60%; p = 0.006). Both groups identified information provided to patients/families, patient/family participation during transfer, and ICU-ward collaboration as opportunities for improvement. A minority of hospitals used ICU-to-ward transfer tools (11%) of which most (n = 21 unique) were designed to communicate patient information between providers (71%) and comprised six categories of information: demographics, patient clinical course, corrective aids, mobility at discharge, review of systems, and documentation of transfer procedures.
ICU and ward administrators have similar perspectives of transfer practices and identified patient/family engagement and communication as priorities for improvement. Key information categories exist.
将危重症患者从重症监护病房（ICU）转移到医院病房具有挑战性。从 ICU 转来的患者护理方面的不足与更高的医疗保健成本和对护理的不满有关。对于医院病房提供者如何接受这些患者的护理，以及他们认为哪些方面的转移需要改进，知之甚少。
比较 ICU 和病房管理员对 ICU 到病房的转移实践的看法，并评估转移工具的内容。
横断面调查设计。
我们向 128 名内科和/或外科 ICU 以及 256 名病房管理员发放了一份调查，以了解他们对 ICU 转移实践的看法。我们对从受访者那里收到的 ICU 转移工具进行了定性内容分析。
共有 108 名（77%）ICU 和 160 名（63%）病房管理员对调查做出了回应。报告称，ICU 主治医生对患者转移的安全性负有“主要责任”（93%对 91%；p=0.515）。ICU 管理员比病房管理员更普遍地认为在患者转移中会常规包括出院总结（81%对 60%；p=0.006）。两组都确定了向患者/家属提供的信息、患者/家属在转移过程中的参与以及 ICU-病房协作作为改进的机会。少数医院（11%）使用 ICU 到病房的转移工具，其中大多数（n=21 个独特的）旨在在提供者之间传递患者信息（71%），并包含六个信息类别：人口统计学信息、患者临床病程、矫形辅助设备、出院时的移动能力、系统回顾和转移程序记录。
ICU 和病房管理员对转移实践有相似的看法，并确定了患者/家属的参与和沟通是改进的重点。存在关键信息类别。
