Transfer Bundle Use in the Intensive Care Unit: a Quality Improvement Project in a Neurosurgical Intensive Care Unit

Abstract

Background: Transfer out of the intensive care unit (ICU) is known to be one of the most stressful times in a patient’s hospital course. “Transfer anxiety” or “relocation stress” is affected by factors including: higher nurse to patient ratios outside of the ICU, decreased monitoring and surveillance, and poor planning and preparation for the transfer itself. A 14-bed neurosurgical ICU at a large, urban, academic hospital had no transfer process in place. An informational transfer bundle was implemented over 13-weeks as part of a quality improvement (QI) project.

Methods: Data were collected using a pre and post-test survey, a transfer checklist, and the Systems Usability Scale survey tool. Descriptive data analysis was performed at the conclusion of the 13-week QI project.

Results: Nurses perceptions of having an appropriate transfer process in place, and patients and families viewing transfer in a positive light increased post-implementation, however, notification of transfer itself was still low. The transfer brochure use was viewed favorably nurses, with greater than 90% reporting “agree” or “strongly agree” that its use helped in the transfer process. Patients/families reported increased comfort with transfer process through feedback during dissemination of the brochure. The Checklist showed that 29% of respondents had less than 24-hour notice of transfer and 62% had no family present at the time of brochure review. The goal of 20 completed checklists was met with 20 total transfers completed with checklist, although 5 appropriate transfers were missed.

Conclusions: There is a need for a more formal transfer process and timely notification of impending transfer. Nursing, support staff, and management viewed the project favorably, stating the brochure helped patients and their families feel more prepared for transfer. Sustainability of the project will include use of the brochure on at least 2 other ICU’s and addition to current ICU checklist used during rounds. Overall, the project helped facilitate smoother transfer process for patient/family.