Improving communication of patient issues on transfer out of intensive care

Abstract

The written medical handover document is frequently poor in quality and highly variable which raises concerns about patient safety. Intensive care unit (ICU) patients have complex medical and social issues which increases the risk of errors during ongoing hospital treatment. Our project team of four doctors and two nurses aimed to improve the documentation of patient problems as they leave the ICU.A literature review and process mapping of both medical and nursing transfer documentation helped in understanding the current process. Current problems (CP) were defined as any patient issues which require ongoing thought, management or follow-up.Our progress was tracked using a measure of the number of CPs listed in the free-text field titled ‘Current Problems’ in 50 medical transfer documents. This was graphed on a control chart showing a process in statistical control. Means and control limits were recalculated whenever a process shift occurred.There was no relationship between the number of CPs listed and length of ICU stay, age of patient, or severity of illness on presentation (Acute Physiologic Assessment and Chronic Health Evaluation II score). An inter-relationship graph identified the key drivers which were amenable to change: (1) the doctors completing the clinical summary at the time of discharge did not have all the information readily available to them and (2) the doctors were uncertain of the types of problem which should be communicated.Improvements were designed and trialled using Plan-Do-Study-Act cycles to address these two key drivers. At baseline, the average number of CPs per patient was 1.8. After implementation of a paper problem list at the patient bedside, with supporting education, the average increased to 2.7. This was further improved by the addition of a checklist of common patient problems. This increased the average to 3.85.These improvements were permanently implemented and ongoing audits have shown sustained improvement using statistical process control methods.

Comunicação entre equipes e a transferência do cuidado de pacientes críticos

“…Um mapeamento realizado com documentos de transferência corrobora estes achados ao evidenciar variabilidade e inconsistência, tais documentos sendo sinalizados pela equipe receptora como incompletos e de baixa qualidade. Como causa apontada para a problemática cita-se as trocas de profissionais nos turnos de trabalho como fator influente para desconhecimento de todas as informações do paciente (16) .…”

Family caregivers' experiences and needs of transitional care during the transfer from intensive care unit to a general ward: A qualitative study

“…The findings in the study showed that the communication and cooperation between ICU, ward and family members were short of effectiveness, which not only hindered the implementation of nursing safety in the transition period but also affected the transmission and acquisition of information for health promotion. Roberts et al (2018) have demonstrated that inaccuracies and omissions in information not only elevate the risk of adverse events but also reduce patient satisfaction. It is strongly recommended to combine oral and written communication to support information exchange during transitional care (Stelfox et al, 2017).…”

“…ICU transitional care refers that ICU nurses and/or other medical workers provide ICU patients with minimal interruption and the best continuity of intensive care services to avoid the sudden interruption of intensive care after ICU transfer, which could ensure the safety of patients and improve the quality of care (Chaboyer et al, 2005). The transition period of ICU to a general ward is a complex process, which is closely related to medical errors, unplanned return to ICU, increased risk of adverse events, and even death, leading to the fragility of patients and the need for more complex care (Niven et al, 2014; Roberts et al, 2018). Coughlin et al (2018) have conducted a retrospective analysis of 446 cases who returned to the neurosurgery ICU within 3 years, displaying that the readmission rate was 39% in ICU, of which 17% of patients died in hospital.…”

Impacto da implementação de um protocolo sistematizado de transferência de informações na qualidade dos relatórios de alta da UTI em pacientes submetidos à cirurgia de revascularização miocárdica

“…Estratégias de melhorias, como treinamentos às habilidades de comunicação verbal também devem ser realizadas, assim como o acompanhamento das medidas estabelecidas. Questionários de satisfação são úteis a este respeito (Arora e Johnson, 2006) e a adoção de políticas e intervenções ao aprimoramento das rotinas deve incluir estratégias de reavaliações e reciclagens, como PDSA (Plan, Do, Study, Act) Planejar, Realizar, Estudar e Atuar (Roberts et al, 2018). A escolha do melhor local para transferência de informações é importante.…”