Standardized Transfer Process for a Neurointensive Care Unit and Assessment of Patient Bounceback
- 17.11.2021
- Original work
Erschienen in:
- Verfasst von
- Cody L. Nathan
- Laura Stein
- Lisa J. George
- Bethany Young
- Jessica Fuller
- Brianna Gravina
- Phyllis Dubendorf
- Scott E. Kasner
- Monisha A. Kumar
- Erschienen in
- Neurocritical Care | Ausgabe 3/2022
Abstract
Background
Patients who require readmission to an intensive care unit (ICU) after transfer to a lower level of care (“bounceback”) suffer from increased mortality and longer hospital stays. We aimed to create a multifaceted standardized transfer process for patients moving from the neurointensive care unit (neuro-ICU) to a lower level of care. We hypothesized that this process would lead to improvement in provider-rated safety and a decreased rate of bouncebacks to the neuro-ICU after transfer.
Methods
The study took place at the Hospital of the University of Pennsylvania from October 2018 to October 2020. A standardized five-step transfer process was created and implemented for transferring patients from the neuro-ICU to a lower level of care. Patient care providers completed a survey before and after implementation of the protocol to assess a variety of components related to safety concerns when transferring patients. The rate of bouncebacks pre and post intervention was calculated by using a two-sample Wilcoxon rank-sum test, and disposition at discharge was calculated by using Fisher’s exact test.
Results
Of the 1176 total patient transfers out of the neuro-ICU, 29 patients bounced back within 48 h. The average age of patients who bounced back was 63.3 years old, with a similar distribution among men and women. The most common reason for bounceback was respiratory distress, followed by cardiac arrhythmia, stroke, and sepsis. Implementation of the standardized process led to a decrease in provider-rated concern of overall safety (5 to 3, p = 0.008). There was improvement in transfer delays due to bed availability (3 to 4.5, p = 0.020), identification of high-risk patients (5 to 6, p = 0.021), patient assignment to the appropriate level of care (5 to 6, p = 0.019), and use of the electronic medical record handoff indicator (5 to 6, p = 0.003). There was no statistically significant difference in terms of patient bounceback rate after implementation of the process (2.4% vs. 2.5%, p = 1.00) or patient disposition at discharge (p = 0.553).
Conclusions
Patients who bounceback to the neuro-ICU within 48 h had an increased length of hospital stay, had an increased length of ICU stay, and were more likely to be intubated for more than 96 h. Implementation of a standardized five-step transfer process from the neuro-ICU to a lower level of care resulted in improvement in multiple provider-rated safety outcomes and identification of high-risk patients but led to no difference in the patient bounceback rate or patient disposition at discharge.
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- Titel
- Standardized Transfer Process for a Neurointensive Care Unit and Assessment of Patient Bounceback
- Verfasst von
-
Cody L. Nathan
Laura Stein
Lisa J. George
Bethany Young
Jessica Fuller
Brianna Gravina
Phyllis Dubendorf
Scott E. Kasner
Monisha A. Kumar
- Publikationsdatum
- 17.11.2021
- Verlag
- Springer US
- Erschienen in
-
Neurocritical Care / Ausgabe 3/2022
Print ISSN: 1541-6933
Elektronische ISSN: 1556-0961 - DOI
- https://doi.org/10.1007/s12028-021-01385-z
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