Standardizing ICU-to-Ward Transitions: Introducing and Refining ICU-PAUSE in the Process of Medical Intensive Care...

Intensive care unit-to-ward transitions are high-risk processes in which unstandardized communication can contribute to adverse events. Structured handoff tools such as ICU-PAUSE can improve these transitions. Thus, the authors introduced the standardized ICU-PAUSE framework and reassigned authorship from the receiving ward team to the sending ICU team and evaluated the impact of these interventions. A survey-based pre-post, staged quality improvement study of the ICU-to-ward transfer process at a single academic medical center was conducted. Internal Medicine housestaff were surveyed before and after the introduction of the tool to assess their satisfaction with the changes and their understanding of the patient's ICU course. The intervention was supplemented by 2 targeted educational sessions based on housestaff feedback. The first session was followed by a posteducation survey assessing similar domains as prior surveys but also focusing on perceptions of authorship and education. There was no difference in mean provider satisfaction scores pre- vs postintervention (6.0 vs 5.9, P = 0.75). Understanding of the ICU course was similar between pre- and postintervention surveys, although most respondents perceived ICU-PAUSE and targeted education to improve care transitions. After education, 67.9% of attendees reported an improved level of comfort writing ICU-PAUSE notes, and 61.2% believed ICU-PAUSE improved transitions of care. Most respondents (81.6%) believed the sending ICU team was best equipped to write the transfer notes. Standardizing the ICU downgrade note and changing authorship had no impact on provider satisfaction. However, providers felt authorship was best assigned to the ICU team.