Patient Transfers out of ICU

Transfer out of ICU is a Very High Risk Time for Patients

Communication with Accepting Service is Mandatory and Essential

Transfer out of ICU is a Very High Risk Time for Patients

There is an entire body of literature on the risks involved in patient transfers out of the ICU

Patients leaving the ICU are still among the sickest patients in the hospital

Our patients are complex and transfers out of ICU put them at increased risk for errors, adverse events, readmission, dissatisfaction with care, and death

Patients are transitioning from a high tech 1:1 nursing unit to a less acute environments with a lower nurse: patient ratio

Many levels of the health care team are involved in exchanges of information and responsibility.

Patients are, at times, being transferred to services that do not know them well

Transfers out happen day or night depending on need to transfer in

Very High Stress Time for Families

Communication with Accepting Service is Mandatory and Essential

Transfer out of ICU is a Very High Risk Time for Patients

Families become accustomed to our availability and presence in the the ICU

They feel the patient is protected in an environment of monitors and 1:1 nursing

They become alarmed by the decrease in availability of staff and can blame "the ward" or too early of a discharge from ICU for any deterioration that occurs

Some families are left with guilt for not having been there if a patient deteriorates on the ward or not having advocated that they remain in ICU

Communication with Accepting Service is Mandatory and Essential

Communication with Accepting Service is Mandatory and Essential

Communication with Accepting Service is Mandatory and Essential

MD to MD sign over is a part of patient care and a responsibility that cannot be overemphasized given the dangers that exist

During the day, the resident assigned to the patient must notify the accepting service of intent to transfer.

During the day, the resident looking after the patient must contact the accepting service when a bed is assigned

If the transfer happens at night, one of the two residents on call must contact the accepting resident to ensure they are aware that the patient will be on their ward and will become their responsibility

This communication allows the accepting service an opportunity to assess the patient before or after arrival to their ward and review the transfer ordered

If you are unable to complete this task, notify the ICU attending or fellow and we will ensure the service is aware.

Quality Transfer Note is Essential

Quality Transfer Note is Essential

Communication with Accepting Service is Mandatory and Essential

The transfer note is the single most important note you will write for the patient and should compliment what you've already communicated in the MD to MD verbal sign over

If you make your daily progress notes of good quality with updated information, the transfer note should not be onerous

Imagine yourself on the receiving end of the note and make the content succinct, informative, and pertinent

Anything that requires follow up should be in your note

Every drug the patient is on should be accounted for in your note

Pertinent family discussions where goals of care have been established should be summarized and referenced

Any tests that require follow up should be noted

Reconcile and Clean Up Orders

Quality Transfer Note is Essential

Reconcile and Clean Up Orders

Although you should be auditing patient orders daily, make sure the discharge orders are reconciled

Patients should not leave the ICU with IV opioid orders, propofol, ventilator orders, any of the PEDDS orders, blood gases etc, on a regular basis.

Mandatory RACE Follow Up

Quality Transfer Note is Essential

Reconcile and Clean Up Orders

We provide mandatory RACE follow up the following day (or two, or more) on all of our ICU discharges for all of the reasons cited above and to ensure a smooth transition between services