EVERY PATIENT MUST HAVE A DESTINATION: TRANSITIONING CARE WITHIN THE INTENSIVE CARE UNIT

Abstract

In a surgical intensive care unit, patient turn-over is frequent. In our CVICU, 96.3% of patients stay less than 24 hours. Patients that require prolonged mechanical ventilation fall outside of the routine care process and often require more complex interventions and longer time in ICU. In 2011, interprofessional, long-term care rounds were developed to discuss all patients residing in the CVICU for more than 7 days. The intent was to: identify and understand patient/family issues; improve the coordination of care between nursing, health disciplines and medicine; and develop a more holistic approach to the care of patients receiving prolonged intensive care. More recently, attention has been given to a fundamental tenant in our unit: “every patient must have a destination”. There is a recognition that patients need to transition to other areas, including the ward, ventilation weaning units, or referring hospitals. With this in mind for long-term ICU patients, care needs to re-focused and both short and long term goals need to be set. To that end, we have created a guideline/checklist to use proactively at weekly long-term care rounds, which addresses issues such as de-medicalization the patient, development of a written weaning and mobility plans, increasing patient/family involvement in care, and initiating communication with future care facilities/units. Future evaluation will assess the impact this tool has had on our long-term ICU patients.