What factor is advocated for collectively by patients, physicians, and nurses when transferring a patient from Intensive Care Unit (ICU) to a ward?

Communication as the Key Factor in ICU to Ward Patient Transfers

The most important factor advocated for collectively by patients, physicians, and nurses when transferring a patient from ICU to ward is effective communication. 1, 2

Communication Challenges During ICU to Ward Transfers

• ICU to ward transfers are characterized by failures in communication, which are experienced differently by patients, ICU physicians, ward physicians, ICU nurses, and ward nurses 3
• Communication breakdowns during transfers can lead to adverse patient outcomes, particularly for complex patients such as trauma patients 4
• Patients and providers attribute breakdowns in ICU-to-ward transfers primarily to communication issues, alongside resource availability and institutional culture 2

Communication Elements Valued by All Stakeholders

Standardized Communication Tools

• Written information provided to families can ease the transition out of the ICU 1
• Standardized communication tools that streamline provider-to-provider and provider-to-patient communication are recommended by both patients and providers 2, 5
• A total of 63 distinct information elements have been identified as essential for inclusion in an ICU transfer summary tool 5

Multimodal Communication Approaches

• Multimodal communication facilitates timely, accurate, and mutually reinforcing information transfer 2
• ICU physicians and nurses typically report communicating with ward counterparts via telephone (78% and 75% respectively) 3
• Face-to-face handover is specifically recommended by physicians to improve transfer quality 3

Patient and Family Involvement

• Patients report higher satisfaction with transfers when they:
  • Receive more information about the transfer (OR 1.32,95% CI 1.18-1.48)
  • Have their questions addressed (OR 3.96,95% CI 1.33-11.84)
  • Meet the ward physician prior to transfer (OR 4.61,95% CI 2.90-7.33)
  • Are assessed by a nurse within 1 hour of ward arrival (OR 4.70,95% CI 2.29-9.66) 3
• Patients specifically recommend being informed about pending transfers in advance 3

Barriers to Effective Communication During Transfers

• Discrepancies exist between what ICU staff report communicating and what ward staff report receiving 3
• ICU physicians and nurses report providing more elements of clinical information than ward physicians (mean 4.7 vs. 3.9, p<0.001) and nurses (mean 5.0 vs. 4.4, p<0.001) report receiving 3
• Nurses identify interruptions, time constraints, and workload pressures as significant barriers to effective handover 4
• Transfers occurring at shift changes are particularly problematic according to nurses 3

Facilitators of Effective Communication

• Teamwork where preparation and the handover event are prioritized over other activities 4
• Nurses' ability to speak up and present clinical changes is essential for accurate and effective dialogue 6
• Establishment of shared goals and clinical understanding between ICU and ward staff 6
• Open dialogue and willingness of all parties to listen to each other 6
• Having a documented care plan travel with the patient is recommended by all stakeholders 3

Recommendations for Improving Communication During Transfers

• Implement standardized, multimodal communication tools that include essential information elements 2, 5
• Develop specific procedures to manage delays in transfer to ensure continuity of care 2
• Include patients and families in the transfer process with clear communication about what to expect 3
• Ensure nurses' ongoing observations of patients are included in care discussions with physicians 6
• Prioritize face-to-face handovers between ICU and ward staff whenever possible 3
• Avoid scheduling transfers during shift changes 3