Moving patients from emergency department to medical intensive care unit: Tracing barriers and root contributors

Abstract

BackgroundPatient transfers involve the physical movement of patients, along with the transfer of their care-related information, responsibility, and control between sending and receiving clinicians. Patient transfers between critical care units are complex and vulnerable to bottlenecks. ObjectiveTo examine the patient transfer process from emergency department (ED) to medical intensive care unit (MICU). Materials and MethodA qualitative study on transfers from ED to MICU was conducted at two academic hospitals. Using a process-based methodological approach supported by shadowing of patient transfers and clinician interviews, we examined the process-based similarities and differences in barriers and strategies used across hospitals. ResultsPhases underlying ED-MICU transfer process included: pre-transfer phase involving ED care coordination and MICU transfer decision-making; transfer phase involving ED-MICU resident handoff, and post-transfer phase involving MICU care planning and management. Discussion and ConclusionTransfer of information, responsibility and control between sending and receiving clinicians is key to effective management of interdependencies between the pre-transfer, transfer and post-transfer phases underlying the patient transfer process. Evidence-based strategies to address challenges related to transfer of information, responsibility and control include the use of videophones and communication checklists, the allocation of a crash bed, engagement of sending, receiving and consulting teams in the physical movement of patients, and in-hospital transfer protocols.