Implementation of a Transition of Care Process to Reduce Patient/Family Relocation Stress/Anxiety

Abstract

Background Transitions of care in the acute care system are a process patients encounter frequently, involving vulnerable populations such as the intensive care unit patients. The transition process in the intensive care unit aims for minimal disruption, however, patients/families still experience stress/anxiety. Transitioning from a secure and specialized care area to another unit induces fear of the “unknown.” A support process during the transfer is essential for a positive patientcentered transition of care. Local Problem The project goal of this quality improvement project was to develop and implement a transition process in the surgical intensive care unit to reduce patient/family relocation stress/anxiety. Interventions The project took place over an 8-week timeframe within a 24-bed adult surgical intensive care unit. Meleis’ Middle-Range Transition Theory Framework was used to develop the project. The PDSA model guided the development and implementation. A pre-post design was used with separate populations, the pre-group providing baseline information. Surgical intensive care unit nurses were educated on the process during staff meetings prior to implementation. Patients transitioning to the surgical intermediate care unit participated. The process included an algorithm checklist for nurses addressing: unit information, decreased patient monitoring, family visiting, patient safety, transition brochure of expectations, and self-reported post-transition data. Surgical intensive care unit champions collected data within 48 hours of transfer from patient/family self-report using the data sheet, composed of the Faces Anxiety Scale, brochure feedback, and staff compliance data. Post implementation, nurses complete the transition of care- system usability survey to evaluate process feedback. Results Pre-implementation Faces Anxiety Scale data (N=6), 33% displayed a little bit more stress/anxiety with transitions and 50% a bit more, with 83% from patient completion of data and 17% family. Post-implementation (N=24), 42% displayed no stress/anxiety and 37% just a little, 75% completed by patients and 25% family. Pre demographics displayed majority male gender, and post-indicated equivalence of gender, however both were patients over family completing the data. Pre-implementation data found a majority in the 20-39 and 60-79 age groups, and postimplementation date, majority was in 40-59 and 60-79 age groups. The transition of care- system usability survey indicated 97% of surgical intensive care unit nurses would like the transition process continued. Conclusions The surgical intensive care unit transition of care process for patients/families is paramount to impacting goals toward reducing relocation stress/anxiety. Outcomes discussed indicated success, and positive surgical intensive care unit nurse feedback indicated the need and want for the transition of care process to all transitioning units for surgical intensive care unit patients, as well as identifying the clear need for the practice change.