Formative Perceptions on Structured Transfer Escalation: Proactive and Unified Process (STEP-UP) for Inter-ICU...

Inter-ICU transfer of patients with acute respiratory failure occurs between hospitals to facilitate specialized care or treatment options. However, no uniform guidance exists to help clinicians decide why or when patients should be transferred. This lack of guidance contributes to inequities in transfers leading to negative impacts on quality of care and patient-centered outcomes. The objectives of this study were (1) to examine ICU clinicians' perception on the transfer processes within a large health system, (2) to develop a novel Structured Transfer Escalation: Proactive and Unified Process (STEP-UP) for inter-ICU transfer of acute respiratory failure (ARF) patients, and (3) to gather feedback on the relevance of STEP-UP for future work.

The authors employed Consolidated Framework for Implementation Research (CFIR) 2.0 as a framework throughout this mixed-methods study. Eighty-six ICU clinicians from seven hospitals responded to a survey about perceptions on inter-ICU transfers. 72.1% of participants felt that it was feasible to identify patients who would benefit from transfer and 89.5% felt that an earlier decision would be ideal for patient outcomes. An expert panel used the survey data to develop STEP-UP with two components: (a) a time-based decision-making query regarding transfer and (b) a checklist of key tasks to facilitate shared decision-making, collaborative discussion, and standardized sign-out to accomplish a transfer. Qualitative interviews of 19 clinicians revealed the lack of structure during transfers as a recurring theme, and the majority of clinicians perceived STEP-UP as comprehensive and easy to apply.

The authors identified facilitators (for example, health system with a network of hospitals, positive clinician attitudes, and hospital culture around transfers) and barriers (for example, limited bed availability, asymmetric communication) to be considered in future work around a structured system for transfers.