Moving patients from emergency department to medical intensive care unit: Tracing barriers and root contributors.

BACKGROUND:Patient transfers involve the physical movement of patients, along with the transfer of their care-related information, responsibility, and control between sending and receiving clinicians. Patient transfers between critical care units are complex and vulnerable to bottlenecks. OBJECTIVE:To examine the patient transfer process from emergency department (ED) to medical intensive care unit (MICU). MATERIALS AND METHOD:A qualitative study on transfers from ED to MICU was conducted at two academic hospitals. Using a process-based methodological approach supported by shadowing of patient transfers and clinician interviews, we examined the process-based similarities and differences in barriers and strategies used across hospitals. RESULTS:Phases underlying ED-MICU transfer process included: pre-transfer phase involving ED care coordination and MICU transfer decision-making; transfer phase involving ED-MICU resident handoff, and post-transfer phase involving MICU care planning and management. DISCUSSION AND CONCLUSION:Transfer of information, responsibility and control between sending and receiving clinicians is key to effective management of interdependencies between the pre-transfer, transfer and post-transfer phases underlying the patient transfer process. Evidence-based strategies to address challenges related to transfer of information, responsibility and control include the use of videophones and communication checklists, the allocation of a crash bed, engagement of sending, receiving and consulting teams in the physical movement of patients, and in-hospital transfer protocols.