Table 4:

Suggestions to improve transfers from ICU to hospital wards

SuggestionsICU providersWard providersPatient or family member of patientQuote
Implement standardized discharge communication tools to ensure continuity of communication between providers and patients and their families (e.g., standardized written summary of patient course in ICU and treatment plan)“I like to keep communication [with patients and families] very patient focused, to be explicit … about the main issues. … some sort of written template where we see ‘the main issues of the day included the following’ would be a huge benefit.” ICU provider (Interview 16)
Implement standardized discharge communication tools to ensure continuity of communication between providers (e.g., standardized written transfer summary, checklist for verbal handoff)“It would be great if we identified a patient for transfer, the team, that might involve [the] doctor and nurse who are going to accept the patient … and the team that has the patient right now, all getting together close to the patient and family having a multidisciplinary sign-over. And ideally that would be facilitated by a standardized checklist with prompts to talk about specific things to the patient, about the domains that are important.” ICU provider (Interview 18)
Use multimodal communication to document transfer and ensure continuity of care (e.g., verbal, written, electronic)“Communication between the medical teams in different places should occur as both verbal communication and very detailed written communication about all the current issues, the plan, the follow-up plan, the medications. I think both types of communication are important and complementary.” ICU provider (Interview 18)
Develop procedures to manage delays in patient transfer (e.g., scheduled communication updates for patients waiting days for a ward bed)“Just because somebody is up for transfer from ICU yesterday doesn’t mean that they just blindly stay up for transfer; it should be evaluated every day.” Ward provider (Interview 29)
Conduct transfer-of-care handover at the patient bedside (e.g., multiprofessional team huddle with ICU and hospital ward teams and handoff at bedside)“A family meeting prior to transfer where the former ICU team meets with the new ward team … who are going to be caring for them.” Family member (Interview 24)
Ensure necessary resources are available at time of transfer (e.g., bedside nurse for hospital ward available to receive patient)“The ward said they were ready … so we brought [the patient] over there but the respiratory therapist … wasn’t prepared, she didn’t think the patient was coming at the time so we were stuck … for about half an hour in the hallway because there was a lot of controversy and push back from different levels of the hospital so that was kind of a miserable transfer.” ICU provider (Interview 3)
Actively involve attending physician in the transfer process (e.g., verbal handoff between attending physicians)“It wouldn’t be totally unreasonable for the decision about transfer or not transfer to always have to be at least run through over the phone with the internist so they can …go over what they think are the red flags, hear the story, agree that [the transfer] makes sense.” Ward provider (Interview 25)
Ensure essential information is up-to-date at the time of transfer (e.g., current medications and when last administered)“It’s hard to find information about when the last time something was given or their med record so it would be nice to go through the meds [with the ICU provider] because sometimes it takes a long time to put together that chart and you are kind of getting late on med times.” Ward provider (Interview 21)
  • Note: ICU = intensive care unit.