title: A multidisciplinary initiative to standardize intensive care to acute care transitions.
abstract: Transfers from intensive care units to acute care units represent a complex care transition for hospitalized patients. Within our institution, variation in transfer practices resulted in unpredictable processes in which patient safety concerns were raised.
  
  
  METHODS
  Key stakeholders were engaged across the institution. Patient safety ('incident') reports and a staff survey identified safety concerns.
  
  
  METHODS
  Using lean methodology, current transfer processes were mapped for the four adult intensive care units and waste was identified. During a summit of key stakeholders an ideal transfer process was conceived and a structured handoff tool (checklist) was developed. A daily management system (DMS) was implemented to monitor adherence.
  
  
  RESULTS
  The primary process outcome was adherence to the standardized workflow. Audits at 4, 8, and 12 months after implementation indicated that the checklist was used for 100% of transfers. Secondary outcomes included the percentage of transfers completed within a pre-specified time window of 120 minutes, provider notification of patient arrival on the acute care unit, and staff survey responses assessing adequacy of transfer communication.
  
  
  CONCLUSIONS
  Prior work has shown that structuring handoffs can improve patient safety, but the novelty of this project was addressing the transfer process in its entirety, across silos of care. Factors leading to the success of this project were the involvement of key stakeholders across the entire institution early in the project development phase, employment of lean methodology, and implementation of tools to guide workflow adherence and track causes of deviation from the workflow.
authors.affiliation: Division of Hospital Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, USA.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Halvorson
authors.affiliation: Division of Hospital Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, USA.
authors.forename: Brian
authors.initials: B
authors.lastname: Wheeler
authors.affiliation: Division of Hospital Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, USA.
authors.forename: Marge
authors.initials: M
authors.lastname: Willis
authors.affiliation: Division of Hospital Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, USA.|Department of Surgery at Oregon Health & Science University, 3303 SW Bond Ave, Portland, OR, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Watters
authors.affiliation: Division of Hospital Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, USA.
authors.forename: Jamie
authors.initials: J
authors.lastname: Eastman
authors.affiliation: Division of Hospital Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, USA.
authors.forename: Randy
authors.initials: R
authors.lastname: O'Donnell
authors.affiliation: Division of Hospital Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, USA.|Department of Anesthesiology and Perioperative Medicine at Oregon Health & Science University, 3181 S.W.Sam Jackson Park Road, Portland, OR, USA.
authors.forename: Matthias
authors.initials: M
authors.lastname: Merkel
mesh_terms: D057189:Checklist; D003422:Critical Care; D006801:Humans; D033183:Interdisciplinary Communication; D015279:Organizational Culture; D061214:Patient Safety; D010360:Patient Transfer / Q000592:standards*; D017749:Total Quality Management
keywords: checklist; lean management; process mapping; quality improvement; safety culture