Herbst Lori A, Desai Sanyukta, Benscoter Dan, Jerardi Karen, Meier Katie A, Statile Angela M, White Christine M
Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, UC College of Medicine, Cincinnati, OH, USA.
Geriatrics & Palliative Care Division, Department of Family & Community Medicine, UC College of Medicine, Cincinnati, OH, USA.
Transl Pediatr. 2018 Oct;7(4):314-325. doi: 10.21037/tp.2018.08.01.
Transition of care from the intensive care unit (ICU) to the ward is usually an indication of the patient's improving clinical status, but is also a time when patients are particularly vulnerable. The transition between care teams poses a higher risk of medical error, which can be mitigated by safe and complete patient handoff and medication reconciliation. ICU readmissions are associated with increased mortality as well as ICU and hospital length of stay (LOS); however tools to accurately predict ICU readmission risk are limited. While there are many mechanisms in place to carefully identify patients appropriate for transfer to the ward, the optimal timing of transfer can be affected by ICU strain, limited resources such as ICU beds, and overall hospital capacity and flow leading to suboptimal transfer times or delays in transfer. The patient and family perspectives should also be considered when planning for transfer from the ICU to the ward. During times of transition, families will meet a new care team, experience uncertainty of future care plans, and adjust to a different daily routine which can lead to increased stress and anxiety. Additionally, a subset of patients, such as those with new technology, require additional multidisciplinary support, education and care coordination which can contribute to longer hospital LOS if not addressed proactively early in the hospitalization while the patient remains in the ICU. In this review article, we describe key components of the transfer from ICU to the ward, discuss current strategies to optimize timing of patient transfers, explore strategies to partner with patients and families during the transfer process, highlight patient populations where additional considerations are needed, and identify future areas of exploration which could improve the care transition from the ICU to the ward.
从重症监护病房（ICU）向普通病房的护理过渡通常表明患者的临床状况正在改善，但同时也是患者特别脆弱的时期。护理团队之间的过渡带来了更高的医疗差错风险，而安全、完整的患者交接和用药核对可以降低这种风险。ICU再入院与死亡率增加以及ICU和医院住院时间（LOS）延长相关；然而，准确预测ICU再入院风险的工具有限。虽然有许多机制来仔细确定适合转至普通病房的患者，但转科的最佳时机可能会受到ICU压力、ICU床位等资源有限以及医院整体容量和流程的影响，导致转科时间不理想或延迟。在计划从ICU转至普通病房时，也应考虑患者及其家属的观点。在过渡期间，家属将接触新的护理团队，经历未来护理计划的不确定性，并适应不同的日常安排，这可能会导致压力和焦虑增加。此外，一部分患者，如使用新技术的患者，需要额外的多学科支持、教育和护理协调，如果在住院早期患者仍在ICU时没有积极主动地解决这些问题，可能会导致住院时间延长。在这篇综述文章中，我们描述了从ICU转至普通病房的关键组成部分，讨论了优化患者转科时间的当前策略，探讨了在转科过程中与患者及其家属合作的策略，强调了需要额外考虑的患者群体，并确定了未来可能改善从ICU到普通病房护理过渡的探索领域。
