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Development and implementation of a risk identification tool to facilitate critical care transitions for high-risk
Rebecca L Hoffman1, Jason Saucier2, Serena Dasani1
1Department of General Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
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.