Key result
Implementation of a user-designed, structured handover tool increased the proportion of clinicians reporting that the ICU-to-GIM transfer process was adequate from 48.8% to 93.3% (P = 0.03).
Why the study?
In-hospital transfers from the ICU to the general internal medicine ward place patients at risk of adverse events, and a structured handover tool may improve these transitions.
Does a user-designed, structured transfer tool improve the perceived quality of patient transfers from the ICU to the GIM ward among clinicians?
Observational (n=99)
No
Does a user-designed, structured transfer tool improve the perceived quality of patient transfers from the ICU to the GIM ward among clinicians?
Absolute Event Rate: 93.3% vs 48.8%
p-value: p=0.03
A structured, handwritten transfer tool significantly improved clinician-perceived quality of patient transfers from the ICU to general internal medicine wards, though tool completion rates were suboptimal.
Structured transfer tool use improved perceived ICU-to-GIM handoff quality; leaves open effects on safety and requires prospective validation before practice change.
Background In-hospital transfers such as from the intensive care unit (ICU) to the general internal medicine (GIM) ward place patients at risk of adverse events. A structured handover tool may improve transitions from the ICU to the GIM ward. Objective To develop, implement, and evaluate a customized user-designed transfer tool to improve transitions from the ICU to the GIM ward. Methods This was a pre–post intervention study at a tertiary academic hospital. We developed and implemented a user-designed, structured, handwritten ICU-to-GIM transfer tool. The tool included active medical issues, functional status, medications and medication changes, consulting services, code status, and emergency contact information. Transfer tool users included GIM physicians, ICU physicians, and critical care rapid response team nurses. An implementation audit and mixed qualitative and quantitative analysis of pre–post survey responses was used to evaluate clinician satisfaction and the perceived quality of patient transfers. Results The pre–post survey response rate was 51.8% (99/191). Respondents included GIM residents (58.5%), ICU rapid response team physicians and nurses (24.2%), and GIM attending physicians (17.2%). Less than half of clinicians (48.8%) reported that the preintervention transfer process was adequate. Clinicians who used the transfer tool reported that the transfer process was improved (93.3% vs. 48.8%, P = 0.03). Clinician-reported understanding of medication changes in the ICU increased (69.2% vs. 29.1%, P = 0.004), as did their ability to plan for a safe hospital discharge (69.2% vs. 31.0%, P = 0.01). However, only 64.2% of audited transfers used the tool. Frequently omitted sections included home medications (missing in 83.4% of audits), new medications (33.3%), and secondary diagnosis (33.3%). Thematic analysis of free-text responses identified areas for improvement including clarifying the course of ICU events and enhancing tool usability. Conclusion A user-designed, structured, handwritten transfer tool may improve the perceived quality of patient transfers from the ICU to the GIM wards.
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Bodley et al. (2020) conducted an observational in ICU to GIM ward transfers (n=99). User-designed, structured, handwritten ICU-to-GIM transfer tool vs. Preintervention transfer process (informal phone conversation and nonstandardized transfer note) was evaluated on Clinician-reported adequacy of the overall ICU transfer process (p=0.03). Implementation of a user-designed, structured handover tool increased the proportion of clinicians reporting that the ICU-to-GIM transfer process was adequate from 48.8% to 93.3% (P = 0.03).
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