ICU TRANSITION OF CARE

Abstract

TOPIC: Education, Research, and Quality Improvement TYPE: Original Investigations PURPOSE: The aim of our project is to formulate a standardized process for transfering patients from the intensive care unit to the medical wards which improves documentation, policy and puts emphasis on communication through a multidisciplinary approach by utilization of a novel hand-off template and implementation of transfer medication reconciliation. METHODS: Following the IHI model, a fishbone diagram was used to identify areas of improvement in the hand-off process. The persons involved, process, policy, and communication were identified as contributing factors in formulating a standardized Transition Of Care (TOC) process. PDSA cycles were used to test change. We measure use of proposed standardized TOC method and number of ICU re-admissions as part of adverse events. RESULTS: After observing the need for this process to become ubiquitous, using the Plan Do Study Act (PDSA) cycle, literature was reviewed, and a TOC template was formulated in PDSA1 which resulted in no significant change. In PDSA2, there was creation of a policy to utilize an existing Transfer Medication Reconciliation (Med Rec.) with our EMR prior to transferring a patient out of ICU. Internal medicine residents, faculty, ICU attendings, ICU committee, ICU Pharmacy, and EMR Department were educated on the implementation of the new procedure was initiated. 100 charts were analyzed post-intervention; of those 61 charts met inclusion criteria. Twenty seven of the 61 charts had an appropriate use of the TOC Template and use of Transfer Med Rec. in addition to communication with the primary attending (44%). Of these, there was 1 Rapid Response (RR) that warranted an ICU readmission (3.7%). There were 0 code blues after transfer from ICU. Of the 34 charts that did not abide to procedure, there were 3 RRs (8.8%). CONCLUSIONS: There were fewer RR when comparing the patients with the ICU TOC implemented compared to those without the documented communication (3.7% vs 8.8%). The ICU readmission noted, should take into account the inherit fragility of this patient population and associated morbidly. Despite our small sample size, the trends are promising that align with the impact of our implementation of ICU TOC process.The goal of this QI project was to use a multisystem approach to standardized transfer process to ensure patient safety. In our next PDSA cycle, there will be a pop-up screen when a Transfer Order out of ICU is clicked, that directs user to Transfer Med Rec. page before proceeding. With this new implementation, there will be an increased compliance to abiding to the process with integration of the EMR with Transfer Med Rec. CLINICAL IMPLICATIONS: The transition of patient care from the Intensive Care Unit (ICU) to the medical wards has been identified as a crucial time for communication and accuracy in these patients who are at high risk for potential harm due to medical errors. Proper transition process is critical, as the lack of a universal standardized hand-off could lead to detrimental consequences. Our community hospital has an “open” ICU and inconsistent transition of care process has been observed. The focus of our project is to formulate a standardized transfer process that improves documentation, policy and puts emphasis on communication through a multidisciplinary approach with utilization of a hand-off template and implementation of transfer medication reconciliation. DISCLOSURES: No relevant relationships by Victoria Gonzalez, source=Web Response No relevant relationships by Zain Kulairi, source=Web Response No relevant relationships by Sarwan Kumar, source=Web Response No relevant relationships by Bernadette Schmidt, source=Web Response No relevant relationships by DANYAL TAHERI ABKOUH, source=Web Response