What question did this study set out to answer?

The aim was to create a standardized documentation tool to improve the transfer process from medical floors to the ICU.

March 26, 2026Critical Care Medicine0 citations

734: Icu-Pass: Development of a Standardized Floor-to-Icu Transfer Documentation Tool

YCYulei CaoHospital of the University of Pennsylvania TLThomas LuoHospital of the University of Pennsylvania WHWilliam Hewlett

Puntos clave

The aim was to create a standardized documentation tool to improve the transfer process from medical floors to the ICU.
Conducted interviews with residents, ICU teams, and nursing leaders to gather insights on current practices.
Developed and distributed a survey to assess handoff practices and perceptions of documentation.
Created an electronic medical record-based note template based on stakeholder feedback, emphasizing iterative improvement.
VoC interviews revealed unreliable verbal handoff content and significant information loss regarding care goals.
Survey responses indicated that only 29.7% consistently wrote transfer documentation when escalating to the ICU.
Key documentation elements were rated as important, yet only 20.2% recalled goals-of-care discussions being documented.

Resumen

Introduction: Patient transfers from the medical floor to the intensive care unit (ICU) result from acute clinical deteriorations and require high-quality handoffs for safe transitions. At our institution, we recognized a lack of standardized transfer of service documentation. Modeling the success of ICU-PAUSE (ICU downgrade transfer tool), the ICU-PASS initiative sought to standardize floor to ICU transfer documentation. Methods: We conducted voice of customer (VoC) interviews across the Department of Medicine with residents, ICU teams, nursing leaders, and advanced practice providers. We constructed a survey to assess current handoff practice and perceptions of best practices including essential content domains and communication approach. The survey was administered to current clinicians across the department. Based on this feedback, we developed an electronic medical record (EMR) based note template that was iteratively improved by incorporating feedback from stakeholders. Results: Several themes emerged from VoC interviews: a lack of reliability in verbal handoff content, loss of information regarding goals of care and family contacts, and variability in transfer documentation quality. Eighty-five people responded to the survey. 29.7% reported always/almost always writing transfer documentation (TD) when escalating to the ICU. 19% reported consistently seeing TD during floor-to-ICU transfers, and 21.4% found the content mostly helpful when it was present. Elements rated as very/extremely important included ICU transfer indication (73.8%), recent medications (66.7%), goals-of-care (69%), and hospital course (57.1%). Despite being recognized as important, only 20.2% recalled goals-of-care discussions being documented. We created the “ICU-PASS” transfer note which allows multiple users to edit and is partially automated for user friendliness. The note consisted of I: indication for transfer; C: Critical event/resuscitation; U: Uncertainty of diagnosis; P: Pertinent history/hospital courses; A: Access, drain, airway (automated); S: Status/physical exam; S: Support network/goals of care. Conclusions: We created the ICU-PASS tool—a standardized template for floor to ICU transfer—with a design emphasis on being user-friendly and efficient. A post-implementation survey of perceptions of safety is planned.

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