Clinical research study
A Prospective Observational Study of Physician Handoff for Intensive-Care-Unit-to-Ward Patient Transfers

https://doi.org/10.1016/j.amjmed.2011.04.027Get rights and content

Abstract

Background

Poor physician handoff can be a major contributor to suboptimal care and medical errors occurring in the hospital. Physician handoffs for intensive care unit (ICU)-to-ward patient transfer may face more communication hurdles. However, few studies have focused on physician handoffs in patient transfers from the ICU to the inpatient ward.

Methods

We performed a hospitalized patient-based observational study in an urban, university-affiliated tertiary care center to assess physician handoff practices for ICU-to-ward patient transfer. One hundred twelve adult patients were enrolled. The stakeholders (sending physicians, receiving physicians, and patients/families) were interviewed to evaluate the quality of communication during these transfers. Data collected included the presence and effectiveness of communication, continuity of care, and overall satisfaction.

Results

During the initial stage of patient transfers, 15.6% of the consulted receiving physicians verbally communicated with sending physicians; 26% of receiving physicians received verbal communication from sending physicians when patient transfers occurred. Poor communication during patient transfer resulted in 13 medical errors and 2 patients being transiently “lost” to medical care. Overall, the levels of satisfaction with communication (scored on a 10-point scale) for sending physicians, receiving physicians, and patients were 7.9 ± 1.1, 8.1 ± 1.0, and 7.9 ± 1.7, respectively.

Conclusion

The overall levels of satisfaction with communication during ICU-to-ward patient transfer were reasonably high among the stakeholders. However, clear opportunities to improve the quality of physician communication exist in several areas, with potential benefits to quality of care and patient safety.

Section snippets

Study Setting and Sample

Foothills Medical Centre is the sole tertiary care center in Southern Alberta (population 1.8 million). Its 25-bed medical-surgical ICU serves as a regional referral center for trauma, neurosciences, thoracic surgery, and plastic surgery patients. This study was approved by the University of Calgary Conjoint Faculties Research Ethics Board. We enrolled consecutive patients, when investigators were available, who were 18 years of age or older and discharged alive from the medical-surgical ICU at

Study Population Characteristics

During the 5-month study period, 112 patients were successfully recruited (44.6%). The main reason for eligible patient exclusion from participation in the study (patients in the nonstudy group) was patient transfer on nonstudy days when the investigators were not available. Table 1 summarizes the characteristics of the patients screened for the study. The demographic and clinical characteristics of patients in the study group, including ICU length of stay, proportion of transfers occurring at

Discussion

Relatively few existing studies have prospectively and extensively studied the quality of communication surrounding patient transfers from the ICU to the inpatient wards. Our study findings reveal that physicians and patients/families were, for the most part, generally satisfied with physician communication surrounding ICU-to-ward patient transfers. Our findings demonstrate that ICU staff typically notified and explained to patients and families that they were about to be transferred. We also

Acknowledgment

We thank Alan Delosangeles (Department of Critical Care Medicine) for assistance with data acquisition.

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    Funding: None.

    Conflict of Interest: None.

    Authorship: All 3 authors contributed equally to conceiving and designing the study, and analyzing and interpreting the data. Dr Li contributed data collection and writing the manuscript. Dr Stelfox provided critical revision and assisted in statistical analysis of data. Dr Ghali provided critical revision and final approval of the manuscript. All 3 authors had access to data.

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