Prospective cohort study protocol to describe the transfer of patients from intensive care units to hospital wards

Abstract

IntroductionThe transfer of patient care between the intensive care unit (ICU) and the hospital ward is associated with increased risk of medical error and adverse events. This study will describe patient transfer from ICU to hospital ward by documenting (1) patient, family and provider experiences related to ICU transfer, (2) communication between stakeholders involved in ICU transfer, (3) adverse events that follow ICU transfer and (4) opportunities to improve ICU to hospital ward transfer.MethodsThis is a mixed methods prospective observational study of ICU to hospital ward transfer practices in 10 ICUs across Canada. We will recruit 50 patients at each site (n=500) who are transferred from ICU to hospital ward, and distribute surveys to enrolled patients, family members, and healthcare providers (ICU and ward physicians and nurses) after patient transfer. A random sample of 6 consenting study participants (patients, family members, healthcare providers) from each study site (n=60) will be offered an opportunity to participate in interviews to further describe stakeholders’ experience with ICU to hospital ward transfer. We will abstract information from patient health records to identify clinical data and use of transfer tools, and identify adverse events that are related to the transfer.Ethics and DisseminationResearch ethics board approval has been obtained at the coordinating study centre (UofC REB13-0021) and 5 study sites (UofA Pro00050646; UBC-PHC H14-01667; Sunnybrook 336-2014; QCH 14-07; Sherbrooke 14-172). Dissemination of the findings will provide a comprehensive description of transfer from ICU to hospital ward in Canada including the uptake of validated or local transfer tools, a conceptual framework of the experiences and needs of stakeholders in the ICU transfer process, a summary of adverse events experienced by patients after transfer from ICU to hospital ward, and opportunities to guide quality improvement efforts.

Administrator Perspectives on ICU-to-Ward Transfers and Content Contained in Existing Transfer Tools: a Cross-sectional Survey

“…This study was part of a multi-study program of work to reengineer the transition of patients from ICU to ward to improve patient safety, continuity of care, and quality of care. 6,8,18,22 Building on our previous study of ICU stakeholder perspectives on patient care transfer practices, 8 we conducted a national cross-sectional survey of Canadian medical and surgical ward administrators (i.e., directors, unit managers) whose hospital wards routinely accept patients in transfer from the previously studied ICUs. Administrators were asked their perspectives on current transfer practices and any tools used to facilitate the transfer of ICU patients onto their ward.…”

A taxonomy and cultural analysis of intra‐hospital patient transfers

“…Jennings, Sandelowski, and Higgins' (2013) studied transfers in the context of nursing workload. Buchner et al (2015) are studying intensive care unit (ICU) to hospital ward transfers across 10 Canadian hospitals. Yet most studies consider only handoff communication and not patient transfers as a whole.…”

Nurses’ experience of the transfer of ICU patients to general wards: A great responsibility and a huge challenge

“…number of intensive care beds and fewer financial resources can mean that patients move through the system as quickly as possible (Wu & Coyer, 2007) and can also increase night discharges (Goldfrad & Rowan, 2000). Buchner et al (2015) described how premature patient transfer increases the risk of medical error and adverse events, morbidity and mortality (Chaboyer, Thalib, Foster, Ball, & Richards, 2008). It can also lead to ICU readmission and rehospitalisation (Wu & Coyer, 2007).…”