Development and implementation of a risk identification tool to facilitate critical care transitions for high-risk surgical patients. Int J Qual Health Care 2017 Jun 01;29(3):412-419
Date
04/04/2017Pubmed ID
28371889Pubmed Central ID
PMC6281336DOI
10.1093/intqhc/mzx032Scopus ID
2-s2.0-85021358733 (requires institutional sign-in at Scopus site) 12 CitationsAbstract
QUALITY PROBLEM: Patients recently discharged from the intensive care unit (ICU) are at high risk for clinical deterioration.
INITIAL ASSESSMENT: Unreliable and incomplete handoffs of complex patients contributed to preventable ICU readmissions. Respiratory decompensation was responsible for four times as many readmissions as other causes.
CHOICE OF SOLUTION: Form a multidisciplinary team to address care coordination surrounding the transfer of patients from the ICU to the surgical ward.
IMPLEMENTATION: A quality improvement intervention incorporating verbal handoffs, time-sensitive patient evaluations and visual cues was piloted over a 1-year period in consecutive high-risk surgical patients discharged from the ICU. Process metrics and clinical outcomes were compared to historical controls.
EVALUATION: The intervention brought the primary team and respiratory therapists to the bedside for a baseline examination within 60 min of ward arrival. Stakeholders viewed the intervention as such a valuable adjunct to patient care that the intervention has become a standard of care. While not significant, in a comparatively older and sicker intervention population, the rate of readmissions due to respiratory decompensation was 12.5%, while 35.0% in the control group (P = 0.28).
LESSONS LEARNED: The implementation of this ICU transition protocol is feasible and internationally applicable, and results in improved care coordination and communication for a high-risk group of patients.
Author List
Hoffman RL, Saucier J, Dasani S, Collins T, Holena DN, Fitzpatrick M, Tsypenyuk B, Martin NDAuthor
Daniel N. Holena MD Professor in the Surgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
Academic Medical CentersAdult
Aged
Aged, 80 and over
Critical Care
Female
Humans
Intensive Care Units
Male
Middle Aged
Patient Care Team
Patient Handoff
Patient Transfer
Respiratory Insufficiency
Respiratory Therapy
Risk Factors
