8 hours ago We specified 11 physiologic or laboratory criteria indicative of physiologic instability. We determined the time, prior to transfer to the ICU, that each patient first met 1 or more of these criteria. We defined the timing of ICU transfer as the interval between first meeting a physiologic criterion on the hospital ward and transfer to the ICU. >> Go To The Portal
One of the key steps in the transfer planning is to ensure the team receiving the patient has information about the patient’s history in the ICU, and significant events. The MSICU team will review the patient's health history with the receiving health care team.
This study will describe patient transfer from ICU to hospital ward by documenting (1) patient, family and provider experiences related to ICU transfer, (2) communication between stakeholders involved in ICU transfer, (3) adverse events that follow ICU transfer and (4) opportunities to improve ICU to hospital ward transfer.
This should include details of the patient’s condition, the reason for transfer, the names of the referring and accepting consultants, the patient’s clinical status prior to transfer, and details of vital signs, clinical events, and therapy given before and during transfer.
The transfer of critical care patients can occur at various times throughout the admission period (e.g. following the initial stabilization of the patient, for diagnostic or interventional procedures, or for specialist treatment or repatriation). Other indications for patient transfer may be due to bed and staffing availability.
The intra- and inter-hospital patient transfer is an important aspect of patient care which is often undertaken to improve upon the existing management of the patient. It may involve transfer of patient within the same facility for any diagnostic procedure or transfer to another facility with more advanced care.
To help you assess and make decisions about moving a patient, refer to these two useful tools....There are three areas to assess:Is the patient cooperative and able to follow directions? Ask patient to squeeze your hands. ... Can the patient bear weight? ... Can the patient sit up on the side of the bed without support?
A key observation when transferring a patient is to maintain the center of mass. The caregiver is often required to be close to the patient's center of motion which is normally between the shoulders and the pelvis for optimal support. Understanding the patient's limits of stability will help evaluate their balance.
Important elements during patient transfers include stabilizing the patient, maintaining proper communication among all medical staff, and keeping proper documentation. One important concept of patient transfers that nurses and other health care professionals should be aware of is the concept of patient boarding.
Intensive care is appropriate for patients requiring or likely to require advanced respiratory support, patients requiring support of two or more organ systems, and patients with chronic impairment of one or more organ systems who also require support for an acute reversible failure of another organ.
What patient conditions should be observed during a transfer? Observe all changes in the patient's condition, such as pain, dizziness, fatigue, increased pulse rate, and difficulty breathing.
Ensure patient's privacy and dignity. Assess ABCCS/suction/oxygen/safety. Ensure tubes and attachments are properly placed prior to the procedure to prevent accidental removal. A gait belt and wheelchair are required.
A written and informed consent of patient's relatives along with the reason to transfer is mandatory before the transfer. In some countries, dedicated critical care transfer groups have been established to coordinate and facilitate the patient transfer.
Use proper body mechanics:Keep the patient close to you.Keep the patient facing you.Keep your knees bent.Use your leg muscles instead of back muscles as much as possible.Keep a straight, neutral spine (not arched or curved forwards or backwards).Place feet shoulders width apart.More items...•
The receiving hospital must have agreed to accept the transfer; The transfer is done with qualified medical staff and transportation equipment, including the use of necessary and appropriate life support measures; The transferring hospital must send all you medical records related to your emergency condition with you.
Guidelines from the Society of Critical Care Medicine (SCCM) prioritize patients for ICU admission based on projected likelihood of benefit (from highest to lowest priority) as follows5: priority 1: critically ill, needing intensive treatment and monitoring that cannot be provided outside of ICUs; priority 2: not ...
Here are some great gift ideas.Socks and slippers. Anything that makes a stay in the hospital more comfortable is a great gift idea. ... Home-cooked food. ... Card and board games. ... Phone charger extension. ... Books. ... A good pillow.
The association between ICU admission priority categories and the age of patients showed that the patients in the age group <40 years (33.7%) and from 40 to 65 years (37.2%) were more likely to be in priority-1.
This study will describe patient transfer from ICU to hospital ward by documenting (1) patient, family and provider experiences related to ICU transfer, (2) communication between stakeholders involved in ICU transfer, (3) adverse events that follow ICU transfer and (4) opportunities to improve ICU to hospital ward transfer.
Abstract: Transfers from the ICU to the medical ward pose a number of unique risks to patients recovering from critical illness. Several studies have identified communication breakdown among physicians and nurses at the time of transfer as a key vulnerability. This dilemma is particularly challenging in the context of tertiary institutions with high levels of patient acuity and complexity. Unfortunately, no studies are available to provide guidance as to the optimal transfer mechanism in this setting. To describe an innovative reorganization of the transfer process at Wake Forest Baptist Health. Our aim was to collaboratively involve transferring physicians, nurse managers, and hospital bed logistics personnel in a proactive multi-disciplinary daily handoff process.
Abstract: The discharge of patients from the ICU to a hospital ward is a challenging transition of care, attributable to (1) caring for patients with the highest acuity of illness in the hospital, (2) transitioning from a resource-rich environment to one with fewer resources, (3) the number and complexity of providers (multiprofessional and interspecialty) involved, (4) a lack of standardized discharge procedures, and (5) a high frequency of verbal and written communication failures between providers, and between providers and patients/families. There is a growing body of evidence that suggests transitions of care are vulnerable moments in health-care delivery associated with medical errors, adverse events, poor patient satisfaction with care, increased health-care costs, and increased mortality.
This suggests that one potential strategy to improve patient discharge from ICU is to initiate discharge planning early in patients’ ICU stay and potentially overlap the care provided to patients by critical care medicine providers and hospital ward providers both before and after patients leave ICU. This may be particularly important for patients who do not have hospital ward providers engaged in their care throughout their ICU stay. Overlapping provider care, although conceptually attractive, would necessitate effective communication (a frequently reported challenge during discharge) and careful management of the transfer of accountability and responsibility for patient care. Discharge planning tools can help standardize the multistep, multidimensional ICU discharge process and ensure that all essential steps are completed before patients leave the ICU. In addition, they provide an opportunity to engage patients and their families in the discharge process (eg, patient/family information), enhance continuity of care, and potentially reduce transfer anxiety, while improving the patient care experience.
Best practices about ICU transfer include Stepdown Units, discharge strategy checklists, and staffing strategies. We highlight a few key studies below which address best practices in ICU transfer.
On one hand, an SDU alleviates ICU congestion by providing a safe environment for post-ICU patients before they are stable enough to be transferred to the general wards . On the other hand, an SDU can take capacity away from the already over-congested ICU.
Critical care beds are a finite resource. Transfer or discharge of patients from the intensive care unit affects the flow of patients in critical care. Effective whole hospital bed management is key to the successful management of the critical care service. However, admission to the critical care unit alone can be extremely frightening, distressing, and traumatic not only for the patients but their families as well. Although transfer to the medical floors is a positive step toward physical recovery, it can be equally traumatic, and many patients and their families exhibit stress, fear, and anxiety. The purpose of this article was to systematically review the effects of intensive care unit transfer or discharge to medical-surgical floors on adult critically ill patients, their family members and nurses.
The sickest patients in hospitals are cared for in intensive care units (ICUs). More than 5 million patients are admitted annually to ICUs in the United States. 1 The number of patients cared for in ICUs is projected to grow rapidly during the next decade as the average acuity of hospitalized patients rises with growth in the elderly population, who consume the greatest amount of health care services. 2 The increasing number of critically ill patients results in high demands for critical care beds, which in turn necessitates the rapid and sometimes untimely transfer of patients to the medical-surgical floors.
Situation-Background-Assessment-Recommendation promotes patient safety because it helps individuals communicate with each other with a shared set of expectations. It improves efficiency and accuracy through the use and sharing of patient information in a concise and structured format like in the nurse-to-nurse report or handovers. The use of a liaison nurse to coordinate the discharge process has both negative and favorable feedback, as noted in the literature. Chaboyer et al 29 demonstrated that the use of a liaison nurse did not have a statistically significant beneficial effect on of pretransfer anxiety among patient and families. However, the study conducted by Hall-Smith et al 38 showed that the CNS assisted the patients in their transition to the floors and home by acting as a facilitator in the process. Care conferences were also found to be beneficial in reducing the anxiety experienced by family members when the patient is transferred to the general medical floors. 28 There are other additional considerations for improvement suggested: looking at the time of day when the patient is discharged from ICU and the suggestion to conduct more rigorous random controlled trials on this topic.
Individual reports can be any research study, including qualitative methods, literature and systematic reviews, meta-analysis, and QA/QI and TQM reports or expert opinions. The exclusion criteria included articles about pediatric and neonatal critical care.
For this review, the population of interest includes only adult critically ill patients in all ICUs, their families, and nurses. Patients in pediatric and neonatal ICUs are excluded. The intervention, “ transfer or discharge from ICU,” means all transfers and discharges that occurred in all adult ICUs to the medical-surgical floors. The outcomes of interest are the findings reported as impact of transfer or discharge from ICU from the perceptions of patients, their families, and nurses. These outcomes will be classified under the following headings: physical responses, psychological/emotional responses, environmental stressors, and provision of care. 24 According to the Scottish Intercollegiate Guidelines Network (SIGN), 10 as much as possible, outcomes should be objective and directly related to patient outcomes, but it is also important to include outcomes that are important to patients, rather than focusing entirely on clinical outcomes. Transfer or discharge from ICU to medical-surgical floors is an event that impacts the patients, their families, and nurses on many aspects.
Critical care beds are a finite resource. 12 Critical care capacity is not just the number of physical beds in designated critical care areas. It also includes the resources devoted to supporting actual or potentially critically ill patients away from traditional critical care units. This includes essential services such as physiotherapy, dietetics, speech and language therapy, occupational therapy, pharmacy, imaging, laboratory services, and clerical staff. 13 Transfer or discharge of patients from ICU affects the flow of patients in critical care. According to the Department of Health, National Health Services, 13 effective whole hospital bed management is key to the successful management of the critical care service. The effective management of capacity requires an understanding of the flow of patients through the system and of the potential and actual demands placed upon it. With current pressure for bed allocation, it should be taken into consideration that ( a) critical care services are considered within the assessment of pressure for admissions; ( b) discharge from critical care beds can take place at an appropriate time and to an appropriate location; and ( c) a clinician in overall charge of critical care services is well advised about the whole hospital situation and has the authority to expand and contract the number of critical care beds at speed. Thus, it is necessary that those critically ill patients who meet the criteria for transfer to the medical-surgical floor be discharged from ICU as soon as the bed is available. However, being a critically ill patient in the hectic, high-technology intensive care environment by itself can be extremely frightening, distressing, and traumatic not only for the patients but their families as well. 14-23 Strahan and Brown 24 discussed that a literature review of 23 studies revealed stressors that threaten the patient in the ICU, which are as follows: physical response, environmental stressors, emotional disturbances, and communication difficulties. The high mortality and morbidity of patients also require considerable psychological and emotional support to both the patient and their families. Although transfer to the medical floors is a positive step toward physical recovery, it can be equally traumatic, and many patients and their families exhibit stress, fear, and anxiety associated with relocation from ICU. 7,25 The transfer from the ICU to the medical-surgical floors is also a traumatic event for the family. 22 (p114)
Relocation stress is defined as a state in which an individual experiences physiological and/or psychosocial disturbances as a result of transfer from one environment to another. 27 (p715) This article will include research studies, literature and systematic reviews, meta-analysis, quality assurance/quality improvement (QA/QI), total quality improvement (TQM) reports, or expert opinions on all the phenomena identified relating to transfer or discharge from adult ICU to the medical-surgical floors and its effects on the critically ill patients, their families, and nurses.
The transfer of critical care patients can occur at various times throughout the admission period (e.g. following the initial stabilization of the patient, for diagnostic or interventional procedures, or for specialist treatment or repatriation). Other indications for patient transfer may be due to bed and staffing availability.
The receiving hospital should be informed of the patient’s departure and estimated time of arrival.
Recommendations from the Intensive Care Society 1 include competency- based training for all staff involved in patient transfers (i.e. ambulance crew, air medical crew, medical staff, operating department practitioner, nursing staff, and portering staff). The decision to transfer a patient must be made by the responsible consultant in consultation with colleagues from both the referring and receiving hospitals. All inter- and intra-hospital transfers should be audited, and any adverse event or near miss should be reported.
This refers to transfers that take place within the hospital setting either as part of the admission or discharge process , or to enable surgery, specialist procedures, or diagnostic tests. Although the patient remains within the hospital, they are still exposed to high-risk and unfamiliar environments, and staff need to be mindful of this when undertaking the transfer (see Table 20.2 ).
Set up drug infusions with back-up syringe and pumps, and ensure that colloid and crystalloid infusions are available
Blood components must be transported in a designated sealed transfer box. Once opened the full contents must be transfused within 4 h of breaking the seal (document this time). Traceability documentation must be returned to the referring hospital, and any unused components must be sent to the receiving hospital’s Transfusion Laboratory.
Although the majority of patients report that relocation is a stressful experience, patients also regard transfer to a ward as a sign of improvement in their condition and relief from the stress of the critical care environment.
ICU level care is called critical care for a reason. I am 1:1 for a reason. That person may likely be clinging to life by a thread---and I am not going to allow anyone to roll up when that patient can suffer from the delay in care because you don't want to wait a hot minute while I duff my stuff from my c.diff patient's care.
If you can't get a nurse on the phone, it is probably for good reason. The nurse might be off in MRI with their other patient and not even be aware that they have been assigned another one. Or another patient is coding and they can't come to the phone right now.
I think it is totally crappy to not get report first. I’ve had that happen to me a couple of times and I was so ticked off I could barely hear what the bedside report was.
It should be every time it can be . The nurse should have tried to get someone else, like the charge, to take report.