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A multi-center prospective cohort study of patient transfers from the intensive care unit to the hospital ward

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Abstract

Purpose

To provide a 360-degree description of ICU-to-ward transfers.

Methods

Prospective cohort study of 451 adults transferred from a medical–surgical ICU to a hospital ward in 10 Canadian hospitals July 2014–January 2016. Transfer processes documented in the medical record. Patient (or delegate) and provider (ICU/ward physician/nurse) perspectives solicited by survey 24–72 h after transfer.

Results

Medical records (100%) and survey responses (ICU physicians–80%, ICU nurses–80%, ward physicians–46%, ward nurses–64%, patients–74%) were available for most transfers. The median time from initiation to completion of transfer was 25 h (IQR 6–52). ICU physicians and nurses reported communicating with counterparts via telephone (78 and 75%) when transfer was requested (82 and 24%) or accepted (31 and 59%) and providing more elements of clinical information than ward physicians (mean 4.7 vs. 3.9, p < 0.001) and nurses (5.0 vs. 4.4, p < 0.001) reported receiving. Patients were more likely to report satisfaction with the transfer when they received more information (OR 1.32, 95% CI 1.18–1.48), had their questions addressed (OR 3.96, 95% CI 1.33–11.84), met the ward physician prior to transfer (OR 4.61, 95% CI 2.90–7.33), and were assessed by a nurse within 1 h of ward arrival (OR 4.70, 95% CI 2.29–9.66). Recommendations for improvement included having a documented care plan travel with the patient (all stakeholders), standardized face-to-face handover (physicians), avoiding transfers at shift change (nurses) and informing patients about pending transfers in advance (patients).

Conclusions

ICU-to-ward transfers are characterized by failures of patient flow and communication; experienced differently by patients, ICU/ward physicians and nurses, with distinct suggestions for improvement.

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Acknowledgements

The study was supported by the Canadian Frailty Network (Grant Number CORE 2013-12A). HTS was supported by a Population Health Investigator Award from Alberta Innovates and an Embedded Clinician Researcher Award from the Canadian Institutes of Health Research. RAF was supported by a personnel award from the Heart and Stroke Foundation, Ontario Provincial Office. SMB was supported by a Canada Research Chair in Critical Care Nephrology. We thank Chaim Bell, Paul Boucher, Jamie Boyd, Denise Buchner, Chip Doig, Niall Ferguson, William Ghali, Nancy Marlett, Claudio Martin, Marie McAdams, Daniel Niven, Tom Noseworthy, Peter Oxland, Orla Smith, Sharon Straus, Deborah White, Dan Zuege, and David Zygun for their support in planning and executing this study.

Author information

Authors and Affiliations

  1. Departments of Critical Care Medicine, and Community Health Sciences, O’Brien Institute for Public Health, University of Calgary and Alberta Health Services, Calgary, Canada

    Henry T. Stelfox

  2. Department of Critical Care Medicine and Critical Care Strategic Clinical Network, University of Calgary and Alberta Health Services, Calgary, Canada

    Jeanna Parsons Leigh

  3. Division of Critical Care Medicine and Center for Health Evaluation and Outcome Sciences, St. Paul’s Hospital and University of British Columbia, Vancouver, Canada

    Peter M. Dodek

  4. Department of Anesthesiology and Critical Care Medicine, and CHU de Québec, Université Laval Research Center, Population Health and Optimal Health Practices Research Unit (Trauma-Emergency-Critical Care Medicine Research Group), Université Laval, Québec, Canada

    Alexis F. Turgeon

  5. Department of Medicine, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada

    Alan J. Forster

  6. Centre de Recherche du CHU de Sherbrooke, Universite de Sherbrooke, Sherbrooke, Canada

    Francois Lamontagne

  7. Departments of Medicine and Critical Care Medicine, Sunnybrook Hospital, University of Toronto, Toronto, Canada

    Rob A. Fowler

  8. Department of Critical Care Medicine, University of Calgary and Alberta Health Services, Calgary, Canada

    Andrea Soo

  9. Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta and Alberta Health Services, Edmonton, Canada

    Sean M. Bagshaw

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  1. Henry T. Stelfox
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  2. Jeanna Parsons Leigh
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  9. Sean M. Bagshaw
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Corresponding author

Correspondence to Henry T. Stelfox.

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Conflicts of interest

Funding sources had no role in the design, conduct, or reporting of this study and we are unaware of any conflicts of interest.

Additional information

Take-home message: 360-degree evaluations of ICU-to-ward transfers show failures of patient flow and communication to be common. Patients, ICU/ward physicians and nurses have different transfer experiences and distinct suggestions for improvement.

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Stelfox, H.T., Leigh, J.P., Dodek, P.M. et al. A multi-center prospective cohort study of patient transfers from the intensive care unit to the hospital ward. Intensive Care Med 43, 1485–1494 (2017). https://doi.org/10.1007/s00134-017-4910-1

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  • DOI: https://doi.org/10.1007/s00134-017-4910-1

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