Introduction: Transitions of care are inherently high-risk moments in patients’ hospitalizations, as they involve medical complexity, diagnostic uncertainty, and, in the case of floor-to-ICU transfers, clinical instability. The electronic medical record (EMR) can be leveraged to automate many of the critical components required to ensure durable and accessible handoff documentation. We aimed to improve the quality of transfer documentation during change of service by creating an EMR note template for floor-to-ICU transfers. Methods: Eighty-three sequential floor-to-ICU admissions in January 2025 were reviewed to establish a pre-intervention baseline. We conducted interviews with medical residents, ICU attendings, nursing leaders, and advanced practice providers across the Department of Medicine. Incorporating the needs of each service, we created the ICU-PASS note template in the EMR: Indication for transfer; Critical event; Uncertainty of diagnosis; Pertinent history; Access, drain, airway; Status of patient. After implementation of ICU-PASS, we monitored for compliance every two weeks. Results: Prior to implementation of ICU-PASS, 41 (49%) charts included a note to document transfer from the floor to the ICU. 24 of 41 transfer notes utilized a template; the rest were free text. Among the charts with ICU transfer documentation, there was considerable variability in content and quality, with omission of details of family communication (88%) or pending clinical testing (80%). On average, providers took 83 minutes to write a transfer note from start of note to completion. In the first two months of implementation of the ICU-PASS note, there were a total of 116 overall uses, representing 71% of floor-to-ICU transfers. Compared to baseline, 22% more charts had an ICU transfer note in the EMR (p< 0.01). The time to note completion decreased to 37 minutes when utilizing ICU-PASS. Conclusions: We implemented the ICU-PASS template note, developed with multidisciplinary stakeholder input, to facilitate standardized ICU transfer documentation with key information. The proportion of floor-to-ICU transfers with documentation of transfer notes has increased significantly. We plan to complete post-implementation chart review and surveys to study the effect of ICU-PASS on perceived safety of transfers.
Hewlett et al. (Sun,) studied this question.