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EP.029
Improving the documentation of intra-hospital transfers of critically ill adults at The Christie NHS Foundation Trust

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Improving Intra-hospital Critical Care Transfers

The same level of preparation, care and supervision is required for these transfers as is from one hospital to another, and standardised documentation should be used.[1][2]

Aim

To improve the quality of intra-hospital critical care transfers to meet the standard expected of inter-hospital transfers – the measures of which will particularly focus on documentation.

Method

1. Initial patient case record audit and staff survey

2. SOP & electronic version of checklist implementation, staff education and raising  awareness

3. Re-audit of patient case records

4. SOP alteration, further education and systems improvements

Patient Case Record Audit Results

A retrospective audit of paper and electronic patient case records covering a period of 4 months before and after implementation of changes intended to improve local practice (5 months apart).

During 5 months, improvements were made in 6 of 7 standards.

It is hoped that these improvements in documentation reflect improvements in clinical practice overall.

Note:

The first audit included inpatients on critical care transferred to CT or MRI. In addition to this, the re-audit included new admissions transferred to critical care from medical wards by the outreach service.

Although there are only modest improvements overall, new admissions most likely started at 0% before the outreach service was made aware of the standards.

Staff Survey Findings (n=40)

From a survey of 40 members of the MDT it was found:

•More people had transferred a patient than could remember having completed transfer training
•Although many said that their documentation was routine  - the audit didn’t find this to be the case
•The majority of staff were unaware of standards for these transfers and over half didn’t know that a standardised checklist existed or where to find it

Improvements

An SOP for critical care transfers to ensure consistent practice across teams and departments

A locally modified checklist of a regional version to suit our local patient population and clinical practice

An electronic version of the checklist to ease input and enable integration of data from monitoring equipment

Adoption of regionally accepted transfer bag to allow familiarity across teams and trusts

Grab it Check it Chart it

A poster scheme  to serve as a reminder featuring this slogan to highlight key areas of practice

A programme of local education with plans for an annual “Transfer September”

Conclusion

By instigating this series of improvements we were able to improve compliance with documentation across almost all fields.

However, where the project fell short was ensuring consistency across different teams (critical care unit and outreach service). It is hoped that an inclusive programme of education solves this issue and that in a re-audit further improvements will be seen.

References

[1] The Intensive Care Society. Transfer of the critically ill adult. 2011.

[2] North West Critical Care Networks. Intra and Inter-Hospital Critical Care Transfers. 2016.

A Quality Improvement Project by

Dr Sam Clark (Speciality Doctor)

Dr Vidya Kasipandian (Consultant)

The Christie NHS Foundation Trust

 

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