title: Development and implementation of a risk identification tool to facilitate critical care transitions for high-risk surgical patients.
abstract: OBJECTIVE
  Patients recently discharged from the intensive care unit (ICU) are at high risk for clinical deterioration.
  
  
  METHODS
  Unreliable and incomplete handoffs of complex patients contributed to preventable ICU readmissions. Respiratory decompensation was responsible for four times as many readmissions as other causes.
  
  
  METHODS
  Form a multidisciplinary team to address care coordination surrounding the transfer of patients from the ICU to the surgical ward.
  
  
  METHODS
  A quality improvement intervention incorporating verbal handoffs, time-sensitive patient evaluations and visual cues was piloted over a 1-year period in consecutive high-risk surgical patients discharged from the ICU. Process metrics and clinical outcomes were compared to historical controls.
  
  
  RESULTS
  The intervention brought the primary team and respiratory therapists to the bedside for a baseline examination within 60 min of ward arrival. Stakeholders viewed the intervention as such a valuable adjunct to patient care that the intervention has become a standard of care. While not significant, in a comparatively older and sicker intervention population, the rate of readmissions due to respiratory decompensation was 12.5%, while 35.0% in the control group (P = 0.28).
  
  
  CONCLUSIONS
  The implementation of this ICU transition protocol is feasible and internationally applicable, and results in improved care coordination and communication for a high-risk group of patients.
authors.affiliation: Department of General Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
authors.forename: Rebecca L
authors.initials: RL
authors.lastname: Hoffman
authors.affiliation: Division of Traumatology, Surgical Critical Care & Emergency Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
authors.forename: Jason
authors.initials: J
authors.lastname: Saucier
authors.affiliation: Department of General Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
authors.forename: Serena
authors.initials: S
authors.lastname: Dasani
authors.affiliation: Division of Traumatology, Surgical Critical Care & Emergency Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
authors.forename: Tara
authors.initials: T
authors.lastname: Collins
authors.affiliation: Division of Traumatology, Surgical Critical Care & Emergency Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
authors.forename: Daniel N
authors.initials: DN
authors.lastname: Holena
authors.affiliation: Department of General Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
authors.forename: Meghan
authors.initials: M
authors.lastname: Fitzpatrick
authors.affiliation: Department of General Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
authors.forename: Boris
authors.initials: B
authors.lastname: Tsypenyuk
authors.affiliation: Division of Traumatology, Surgical Critical Care & Emergency Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
authors.forename: Niels D
authors.initials: ND
authors.lastname: Martin
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003422:Critical Care; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration*; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team / Q000458:organization & administration; D062209:Patient Handoff / Q000458:organization & administration*; D010360:Patient Transfer / Q000379:methods / Q000458:organization & administration*; D012131:Respiratory Insufficiency / Q000517:prevention & control; D012138:Respiratory Therapy; D012307:Risk Factors
keywords: critical care; handoff; transitions in care