Latest news with #patienttransfer
Medscape
15-07-2025
- Health
- Medscape
ICU Transfers: A Systematic Approach to Reduce Readmissions
When patients stabilize enough to leave the ICU, the transition should represent progress. Instead, it often marks the beginning of a new set of risks. Research shows that in some patient cohorts, 1 in 8 patients transferred from ICU to general medical wards require readmission to intensive care: a sobering reminder that the complexity of post-ICU care extends far beyond simply discontinuing vasopressors and removing arterial lines. The challenge is particularly acute in hospitals with closed ICU systems, where the critical care team that intimately knows the patient's clinical course hands off care to ward physicians who must rapidly assimilate days or weeks of intensive interventions, complications, and treatment decisions. Despite clinicians' best efforts to ensure seamless transfers, communication gaps, medication reconciliation errors, and premature discontinuation of monitoring can transform what should be a step toward recovery into a dangerous transition. A new framework published in JAMA Internal Medicine offers a systematic approach to this challenge. Researchers described the SIMPLER checklist, developed from more than 60 years of combined ICU transfer experience, as a structured method for ensuring safe transitions from intensive care to general medical wards. The Transfer Challenge ICU patients represent some of the most medically complex cases in the hospital, often accumulating multiple interventions, diagnostic tests, and treatment modifications during extended stays. For the receiving ward physician, understanding this clinical complexity requires substantial cognitive effort, particularly when interpreting accumulated laboratory results, identifying which ICU interventions must be discontinued, and determining appropriate monitoring levels for the new care setting. The cognitive burden extends beyond clinical complexity to judgment under uncertainty. Unlike discharge planning for stable ward patients, ICU transfers involve assessing readiness in patients who may still have significant physiologic fragility. Standard ICU interventions such as arterial catheters and hourly urine output monitoring are typically unavailable on medical wards, requiring careful consideration of which monitoring can be safely discontinued. Communication barriers compound these challenges, especially in closed ICU systems where ward and critical care teams may have limited interaction. Honest differences of opinion about transfer readiness are inevitable: One physician may focus on improving hemodynamic trends while another emphasizes persistent organ dysfunction. These disagreements can result in unprofessional views on clinical judgment and make conflict resolution around difficult cases challenging. Current practice lacks standardized protocols for transfer decision-making. While individual institutions may have informal practices or experience-based approaches, the absence of systematic transfer criteria leaves substantial room for variation in both timing and preparation of ICU-to-ward transitions. The SIMPLER Framework: A Practical Solution The SIMPLER checklist addresses these challenges through a structured seven-step approach that intensivists can use before any ICU transfer. Developed as a mnemonic tool to aid recall, each component targets specific high-risk areas identified in clinical practice. Stable Vital Signs: The first checkpoint focuses on hemodynamic stability and ensures patients can maintain adequate blood pressure without vasopressor support. This requires reviewing recent vital sign trends and confirming that hemodynamic support has been successfully discontinued. Adjoa Boateng Evans, MD 'Rising volumes of complex patients have made ICU beds scarce, leaving intensivists straddling a thin line between ensuring bed availability and transferring patients at the appropriate time,' said Adjoa Boateng Evans, MD, clinical assistant professor of anesthesiology and critical care medicine at Duke School of Medicine, Durham, North Carolina. Intact Aeration: Respiratory readiness extends beyond adequate oxygen saturation. This component assesses the patient's ability to maintain airway protection, meet oxygen demands without high-flow support, and manage secretions independently. Medications Reviewed: Medication reconciliation represents one of the most complex aspects of ICU transfers, requiring careful review of which medications to continue, modify, or discontinue. Matthew S. Casavant, DO, board-certified in obstetrics and gynecology, and founder of South Lake OB/GYN in Florida, emphasizes surgical-specific considerations: 'For my OB patients, I specifically require documentation of estimated blood loss, current hemoglobin levels, and breastfeeding status in transfer notes.' Matthew S. Casavant, DO Prepared Psychology: This component addresses patient and family readiness for transfer. Patients may feel anxious about leaving the intensive monitoring environment, while families often worry about reduced surveillance. The assessment should evaluate patient understanding of the transfer plan. Lingering Catheters: Device management requires systematic evaluation of which ICU-specific monitoring tools can be safely discontinued. Arterial catheters, central venous access, and urinary catheters each carry infection risks that must be weighed against ongoing clinical need. Extreme Laboratory Findings: This step mandates a comprehensive review of recent laboratory results to identify any significant abnormalities that might have been overlooked amid the complexity of ICU care. The review should focus on trends rather than isolated values and ensure that any critical findings have appropriate follow-up plans. Return Plans: The final component involves establishing clear contingency protocols and confirming goals-of-care discussions. This includes defining specific clinical triggers that would warrant ICU readmission and ensuring the receiving team understands the patient's treatment preferences and limitations. Fariborz Rezai, MD, system director of critical care medicine at RWJBarnabas Health, and professor at Rutgers New Jersey Medical School, emphasizes the framework's alignment with best practices: 'ICU patients are some of the sickest patients in the hospital, and they need the right time and resources to transition safely. We prioritize high-quality handoffs regardless of the time of day.' Implementation and Expert Perspectives Successful implementation of structured transfer protocols requires both systematic documentation and enhanced communication strategies. At RWJBarnabas Health, Rezai's team uses 'a standardized ICU transfer note template in our system, which functions much like a checklist, covering every organ system to ensure comprehensive documentation.' This approach is reinforced with direct communication including phone calls, secure messages, and bedside discussions. The communication component proves particularly crucial given the dramatic changes in nursing ratios during transfers. Casavant noted that 'the biggest communication breakdown happens when nursing ratios change dramatically from 1:2 in ICU to 1:6 on the ward.' His institution developed a structured 48-hour bridge protocol where 'the ICU nurse calls the receiving floor nurse at 24 hours post-transfer, and we require a physician-to-physician verbal handoff for any patient who had surgical complications.' Evans said that despite electronic documentation, 'phone calls are often the most effective form of communication. Spoken language allows for a level of nuance and immediacy that written notes often lack, especially for psychosocial concerns that don't fit into organ-system based documentation boxes.' Several institutions have found success with complementary tools. The situation, background, assessment, and recommendation communication framework has proven effective for surgical patients, whereas some centers use intermediate care units staffed by critical care teams. Casavant's team implemented a 'return risk' checklist that identifies patients likely to require ICU readmission within 72 hours, reducing their readmission rate by approximately 15% over 2 years. One notable addition suggested by clinical experience involves disposition planning. Evans points out that 'patients and families always want to know what life will look like post-hospitalization,' recommending that future transfer protocols include information about expected discharge timeline and post-hospital care needs.
BBC News
11-07-2025
- Health
- BBC News
Manx Care updates its advice after patients slept at airport
A health care provider has said the communication with patients "could have been better" after a mix-up saw several sleep at an airport overnight when their flight was Male, who runs a patient transfer feedback group, said nine people returning after treatment spent an "uncomfortable night" at Liverpool John Lennon Airport last said the group had "understood from other passengers" that the hotels were full, but had not checked at the information desk as they were feeling "too unwell" to Care said while it understood the "correct processes" had been followed, a travel warrant had now been updated to highlight the availability of a 24-hour support line. Loganair has the contract with the Manx government to provide flights for non-urgent hospital appointments in the UK, which allow residents to access specialist care not available on the Lowe said the group were had not been not able to secure accommodation due to illness and mobility issues after their evening Liverpool to Ronaldsway flight was cancelled due to fog on 25 June."Many of our patients have terminal illnesses or had undergone painful treatment that day, one had even had surgery," she for those who have travelled to be "considered first" ahead of "fit and healthy passengers" in future, she said patients were "already struggling just to stay alive", which itself was "extremely stressful". 'Standard procedures' Manx Care said although it was "very sorry to hear about the experience", a review of the events had shown the "correct processes were followed on the night".A spokesman said passengers had been advised to book their own accommodation and claim the money back from Loganair, which was "in line with standard procedures in such situations".He said the patient transfer service's 24-hour on-call emergency phone number was also available on the evening, but had only received one phone call. However, he admitted "communications could have been better" and a travel warrant sent to patients prior to any trip had been amended "to emphasise that they can call our out of hours service for help and advice if in difficulty due to travel disruption".A spokesman for Liverpool Airport confirmed a patient quiet room had not been available as it was located within the departure lounge, which closes each day after the final flight has taken the dedicated area was opened "considerably earlier" the following day to accommodate those affected, he space at the airport is funded by the Manx Breast Cancer Support Group, which Ms Male is also a member have also recently been raised about patients travelling to Liverpool for treatment being charged a new £2 "tourist tax" for hotel stays. Read more stories from the Isle of Man on the BBC, watch BBC North West Tonight on BBC iPlayer and follow BBC Isle of Man on Facebook and X.
CTV News
30-05-2025
- General
- CTV News
Flin Flon's patients transferred to Saskatchewan hospitals
WATCH: Nearly a dozen patients at Flin Flon's hospital have been moved to facilities throughout Sask. following an evacuation order. WATCH: Nearly a dozen patients at Flin Flon's hospital have been moved to facilities throughout Sask. following an evacuation order. Nearly a dozen patients at Flin Flon's hospital have been moved to facilities throughout Saskatchewan following an evacuation order in the Manitoba community. Eleven Saskatchewan residents who were admitted to the Flin Flon hospital have been transferred to a handful of Saskatchewan communities including Tisdale, Shellbrook, Moosomin, and Regina. The Saskatchewan Health Authority (SHA) says it began transferring patients just after 6 p.m. on Wednesday. The SHA says it worked closely with the Saskatchewan Air Ambulance to transfer patients. 'There were significant time pressures with the wildfire and the safety concerns, and we had to move very quickly, and move a high number of patients in a quick time period,' said Derek Miller, COO of the SHA. Miller says many people worked tirelessly to transfer the patients – from point-of-care teams in Flin Flon and each of the receiving hospitals to the clinical teams that provided in-flight care, and those who matched patients to an appropriate facility and coordinated with healthcare providers. He says all 11 patients were safely transferred around midnight on Wednesday. 'I'm so proud of the teams. Everybody rallied in order to be able to support those patients and get them safely to a hospital,' Miller said in an interview with CTV News.
