Success Factors for Quality and Safety of Intensive Care Unit Transitional Care – Listening to the Sharp End
Abstract
Purpose: The purpose of this paper was to present success factors for increasing quality and safety of intensive care unit (ICU) transitional care as described by co-workers at the sharp end using the core values of total quality management (TQM) as a theoretical lens.
Methodology/Approach: The study had a qualitative design, with data from nine interdisciplinary focus group discussions, including co-workers from the intensive care and general wards. Data were sorted into TQM core values and analysed using qualitative content analysis.
Findings: Quality and safety in transfer processes requires a holistic view, avoiding silos, shared arenas for collaboration, and evidence-based methodologies and tools for safe transfers.
Research Limitation/Implication: A limitation of this study is that it only portrays the challenges encountered by two hospitals during the process of transitional care in the ICU.
Originality/Value of paper: By using TQM core values as a theoretical lens, we could present a usable, holistic picture of success factors and how to improve the transfer process.
References
Aiken, L.H., 2014. Baccalaureate nurses and hospital outcomes: more evidence. Med Care, [e-journal] 52(10), pp.861-863. DOI:10.1097/MLR.0000000000000222.
Aiken, L.H., Sloane, D.M., Bruyneel, L., Griffiths, P. and Sermeus, W., 2014. Staffing and education of nurses and hospital mortality in Europe-Authors' reply. Lancet, [e-journal] 384(9946), pp.851-852. DOI:10.1016/S0140-6736(14)61482-3.
Alali, H., Kazzaz, Y., Alshehri, A., Antar, M., Alhamouieh, O., Hasan, Z. and Al-Surimi, K., 2019. Reducing unnecessary delays during the transfer of patients from the paediatric intensive care unit to the general ward: a quality improvement project. BMJ open quality, [e-journal] 8(3), e000695. DOI: 10.1136/bmjoq-2019-000695.
Allum, L., Apps, C., Hart, N., Pattison, N., Connolly, B. and Rose, L., 2020. Standardising care in the ICU: a protocol for a scoping review of tools used to improve care delivery. Systematic Reviews, [e-journal] 9(1), 164. DOI:10.1186/s13643-020-01414-6.
Andersson, A.C., Idvall, E., Perseius, K.I. and Elg, M., 2014. Evaluating a breakthrough series collaborative in a Swedish health care context. Journal of Nursing Care Quality, [e-journal] 29(2), E1-E10. DOI: 10.1097/NCQ.0b013e3182a95ff6.
Arvidsson, E., Dahlin, S. and Anell, A., 2021. Conditions and barriers for quality improvement work: a qualitative study of how professionals and health centre managers experience audit and feedback practices in Swedish primary care. BMC Family Practice, [e-journal] 22(1), 113. DOI: 10.1186/s12875-021-01462-4.
Aued, G.K., Bernardino, E., Lapierre, J. and Dallaire, C., 2019. Liaison nurse activities at hospital discharge: A strategy for continuity of care. Revista latino-americana de enfermagem, [e-journal] 27, e3162. DOI: 10.1590/1518-8345.3069.3162.
Bergman, B., Bäckström I., Garvare R. and Klefsjö, B., 2022. Quality From Customer Needs to Customer Satisfaction. 4th Edition. Lund: Lund Studentlitteratur.
Boyd, J.M., Roberts, D.J., Leigh, J.P. and Stelfox, H.T., 2018. Administrator perspectives on ICU-to-ward transfers and content contained in existing transfer tools: a cross-sectional survey. Journal of general internal medicine, [e-journal] 33(10), pp.1738-1745. DOI: 10.1007/s11606-018-4590-8.
Brown, K.N., Leigh, J.P., Kamran, H., Bagshaw, S.M., Fowler, R.A., Dodek, P.M., Turgeon, A.F., Forster, A.J., Lamontagne, F., Soo, A. and Stelfox, H.T., 2018. Transfers from intensive care unit to hospital ward: a multicentre textual analysis of physician progress notes. Critical Care, [e-journal] 22(1), pp.1-8. DOI: 10.1186/s13054-018-1941-0.
Bushe, G., 2007. Appreciative inquiry is not about the positive. OD practitioner, 39(4), pp.33-38.
Cuzco, C., Delgado‐Hito, P., Marin Perez, R., Nunez Delgado, A., Romero‐García, M., Martínez‐Momblan, M.A., Martínez Estalella, G., Carmona Delgado, I., Nicolas, J.M. and Castro, P., 2022. Patients' experience while transitioning from the intensive care unit to a ward. Nursing in Critical Care, [e-journal] 27(3), pp.419-428. DOI: 10.1111/nicc.12697.
Dahlgaard-Park, S.M., 2012. Core values–the entrance to human satisfaction and commitment. Total Quality Management & Business Excellence, [e-journal] 23(2), pp.125-140. DOI: 10.1080/14783363.2012.655067.
Dale, B.G., 2003. Managing Quality. Malden, Mass.: Blackwell.
De Grood, C., Leigh, J.P., Bagshaw, S.M., Dodek, P.M., Fowler, R.A., Forster, A.J., Boyd, J.M. and Stelfox, H.T., 2018. Patient, family and provider experiences with transfers from intensive care unit to hospital ward: a multicentre qualitative study. CMAJ, [e-journal] 190(22), E669-E676. DOI: 10.1503/cmaj.170588.
De Souza, L.B., 2009. Trends and approaches in lean healthcare. Leadership in Health Services, [e-journal] 22(2), pp.121-139. DOI: 10.1108/17511870910953788.
Dematteo, D. and Reeves, S., 2011. A critical examination of the role of appreciative inquiry within an interprofessional education initiative. Journal of Interprofessional Care, [e-journal] 25(3), pp.203-208. DOI: 10.3109/13561820.2010.504312.
DiCuccio, M.H., 2015. The Relationship Between Patient Safety Culture and Patient Outcomes: A Systematic Review. Journal of Patient Safety, [e-journal] 11(3), pp.135-142. DOI: 10.1097/pts.000000000000005.
Elo, S. and Kyngas, H., 2008. The qualitative content analysis process. Journal of Advanced Nursing, [e-journal] 62(1), pp.107-115. DOI: 10.1111/j.1365-2648.2007.04569.x.
Enger, R. and Andershed, B., 2018. Nurses’ experience of the transfer of ICU patients to general wards: A great responsibility and a huge challenge. Journal of clinical nursing, [e-journal] 27(1-2), e186-e194. DOI: 10.1111/jocn.13911.
Fencl, J.L. and Willoughby, C., 2019. Daily Organizational Safety Huddles: An Important Pause for Situational Awareness. AORN Journal, [e-journal] 109(1), pp.111-118. DOI: 10.1002/aorn.12571.
Fine, B.A., Golden, B., Hannam, R. and Morra, D., 2009. Leading Lean: a Canadian healthcare leader's guide. Healthcare Quarterly, [e-journal] 12(3), pp.32-41. DOI: 10.12927/hcq.2013.20877.
Foster, S.T., 2004. Managing quality: an integrative approach. Upper Saddle River, N.J.; Great Britain: Prentice Hall.
Gantner, D., Farley, K., Bailey, M., Huckson, S., Hicks, P. and Pilcher, D., 2014. Mortality related to after-hours discharge from intensive care in Australia and New Zealand, 2005–2012. Intensive care medicine, [e-journal] 40(10), pp.1528-1535. DOI: 10.1016/j.physio.2021.01.007.
Graneheim, U.H., Lindgren, B.-M. and Lundman, B., 2017. Methodological challenges in qualitative content analysis: A discussion paper. Nurse education today, [e-journal] 56, pp. 29-34. DOI: 10.1016/j.nedt.2017.06.002.
Häggström, M., Asplund, K. and Kristiansen, L., 2009. Struggle with a gap between intensive care units and general wards. International Journal of Qualitative Studies on Health and Well-being, [e-journal] 4(3), pp.181-192. DOI: 10.1080/17482620903072508.
Häggström, M., Asplund, K. and Kristiansen, L., 2012. How can nurses facilitate patient's transitions from intensive care?: a grounded theory of nursing. Intensive and Critical Care Nursing, [e-journal] 28(4), pp.224-233. DOI: 10.1016/j.iccn.2012.01.002.
Herling, S.F., Brix, H., Andersen, L., Jensen, L.D., Handesten, R., Knudsen, H. and Bove, D.G., 2021. A qualitative study portraying nurses’ perspectives on transitional care between intensive care units and hospitals wards. Scandinavian Journal of Caring Sciences, [e-journal] 36(4), pp.947-956. DOI: 10.1111/scs.12990.
Hollnagel, E., 2014. Is safety a subject for science? Safety Science, [e-journal] 67, pp.21-24. DOI: 10.1016/j.ssci.2013.07.025.
Krueger, R.A., 2014. Focus groups: A practical guide for applied research. Sage publications.
Lagrosen, Y., 2006. Values and practices of quality management: health implications and organisational differences. Doctoral Thesis. Göteborg: Chalmers University of Technology.
Lynch, J., Cope, V. and Murray, M., 2021. The Intensive Care Unit Liaison Nurse and their value in averting clinical deterioration: A qualitative descriptive study. Intensive and Critical Care Nursing, [e-journal] 63, 103001. DOI: 10.1016/j.iccn.2020.103001.
Russell, J.A., 2012. “She's out of the ICU now. “That's a relief, isn't it?”: the growing problem of ICU recidivism. American journal of respiratory and critical care medicine, [e-journal] 185(9), pp.906-908. DOI: 10.1164/rccm.201201-0152ED.
Sammer, C.E., Lykens, K., Singh, K.P., Mains, D.A. and Lackan, N.A., 2010. What is patient safety culture? A review of the literature. Journal of Nursing Scholarship, [e-journal] 42(2), pp.156-165. DOI: 10.1111/j.1547-5069.2009.01330.x.
Seidl, L.K. and Newhouse, P.R., 2012. The Intersection of Evidence-Based Practice With 5 Quality Improvement Methodologies. JONA: The Journal of Nursing Administration, [e-journal] 42(6), pp.299-304. DOI: 10.1097/NNA.0b013e31824ccdc.
Sila, I. and Ebrahimpour, M., 2002. An investigation of the total quality management survey based research published between 1989 and 2000. International Journal of Quality and Reliability Management, [e-journal] 19(7), pp.902-970. DOI: 10.1108/02656710210434801.
Stelfox, H.T., Lane, D., Boyd, J.M., Taylor, S., Perrier, L., Straus, S., Zygun, D. and Zuege, D.J., 2015. A scoping review of patient discharge from intensive care: opportunities and tools to improve care. Chest, [e-journal] 147(2), pp.317-327. DOI: 10.1378/chest.13-2965.
Sten, L., Ingelsson, P., Bäckström, I. and Häggström, M., 2020. Improving ICU transitional care by combining quality management and nursing science - two scientific fields meet in a systematic literature review. International Journal of Quality and Service Sciences, [e-journal] 12(3), pp.385-403. DOI: 10.1108/IJQSS-03-2020-0033.
Sten, L.M., Ingelsson, P., Bäckström, I. and Häggström, M., 2021. Improving Team Collaboration in Patient Transfer Processes by Co-Workers’ Perceptions and Suggestions. Quality Innovation Prosperity, [e-journal] 25(2), pp.1-18. DOI: 10.12776/qip.v25i2.1559.
Tabanejad, Z., Pazokian, M. and Ebadi, A., 2014. A Systematic Review of the Liaison Nurse Role on Patient's Outcomes after Intensive Care Unit Discharge. International journal of community based nursing and midwifery, 2(4), pp.202-210.
Tanjung, H.P. and Nurwahyuni, A., 2019. The Impact of Clinical Pathway Implementation on Length of Stay and Hospital Cost: A Systematic Review. In: ICPH, 6th International Conference on Public Health 2019. Solo, Indonesia, 23-24 October 2019.
Van Sluisveld, N., Hesselink, G., Van der Hoeven, J.G., Westert, G., Wollersheim, H. and Zegers, M., 2015. Improving clinical handover between intensive care unit and general ward professionals at intensive care unit discharge. Intensive care medicine, [e-journal] 41(4), pp.589-604, DOI: 10.1007/s00134-015-3666-8.
Aiken, L.H., Sloane, D.M., Bruyneel, L., Griffiths, P. and Sermeus, W., 2014. Staffing and education of nurses and hospital mortality in Europe-Authors' reply. Lancet, [e-journal] 384(9946), pp.851-852. DOI:10.1016/S0140-6736(14)61482-3.
Alali, H., Kazzaz, Y., Alshehri, A., Antar, M., Alhamouieh, O., Hasan, Z. and Al-Surimi, K., 2019. Reducing unnecessary delays during the transfer of patients from the paediatric intensive care unit to the general ward: a quality improvement project. BMJ open quality, [e-journal] 8(3), e000695. DOI: 10.1136/bmjoq-2019-000695.
Allum, L., Apps, C., Hart, N., Pattison, N., Connolly, B. and Rose, L., 2020. Standardising care in the ICU: a protocol for a scoping review of tools used to improve care delivery. Systematic Reviews, [e-journal] 9(1), 164. DOI:10.1186/s13643-020-01414-6.
Andersson, A.C., Idvall, E., Perseius, K.I. and Elg, M., 2014. Evaluating a breakthrough series collaborative in a Swedish health care context. Journal of Nursing Care Quality, [e-journal] 29(2), E1-E10. DOI: 10.1097/NCQ.0b013e3182a95ff6.
Arvidsson, E., Dahlin, S. and Anell, A., 2021. Conditions and barriers for quality improvement work: a qualitative study of how professionals and health centre managers experience audit and feedback practices in Swedish primary care. BMC Family Practice, [e-journal] 22(1), 113. DOI: 10.1186/s12875-021-01462-4.
Aued, G.K., Bernardino, E., Lapierre, J. and Dallaire, C., 2019. Liaison nurse activities at hospital discharge: A strategy for continuity of care. Revista latino-americana de enfermagem, [e-journal] 27, e3162. DOI: 10.1590/1518-8345.3069.3162.
Bergman, B., Bäckström I., Garvare R. and Klefsjö, B., 2022. Quality From Customer Needs to Customer Satisfaction. 4th Edition. Lund: Lund Studentlitteratur.
Boyd, J.M., Roberts, D.J., Leigh, J.P. and Stelfox, H.T., 2018. Administrator perspectives on ICU-to-ward transfers and content contained in existing transfer tools: a cross-sectional survey. Journal of general internal medicine, [e-journal] 33(10), pp.1738-1745. DOI: 10.1007/s11606-018-4590-8.
Brown, K.N., Leigh, J.P., Kamran, H., Bagshaw, S.M., Fowler, R.A., Dodek, P.M., Turgeon, A.F., Forster, A.J., Lamontagne, F., Soo, A. and Stelfox, H.T., 2018. Transfers from intensive care unit to hospital ward: a multicentre textual analysis of physician progress notes. Critical Care, [e-journal] 22(1), pp.1-8. DOI: 10.1186/s13054-018-1941-0.
Bushe, G., 2007. Appreciative inquiry is not about the positive. OD practitioner, 39(4), pp.33-38.
Cuzco, C., Delgado‐Hito, P., Marin Perez, R., Nunez Delgado, A., Romero‐García, M., Martínez‐Momblan, M.A., Martínez Estalella, G., Carmona Delgado, I., Nicolas, J.M. and Castro, P., 2022. Patients' experience while transitioning from the intensive care unit to a ward. Nursing in Critical Care, [e-journal] 27(3), pp.419-428. DOI: 10.1111/nicc.12697.
Dahlgaard-Park, S.M., 2012. Core values–the entrance to human satisfaction and commitment. Total Quality Management & Business Excellence, [e-journal] 23(2), pp.125-140. DOI: 10.1080/14783363.2012.655067.
Dale, B.G., 2003. Managing Quality. Malden, Mass.: Blackwell.
De Grood, C., Leigh, J.P., Bagshaw, S.M., Dodek, P.M., Fowler, R.A., Forster, A.J., Boyd, J.M. and Stelfox, H.T., 2018. Patient, family and provider experiences with transfers from intensive care unit to hospital ward: a multicentre qualitative study. CMAJ, [e-journal] 190(22), E669-E676. DOI: 10.1503/cmaj.170588.
De Souza, L.B., 2009. Trends and approaches in lean healthcare. Leadership in Health Services, [e-journal] 22(2), pp.121-139. DOI: 10.1108/17511870910953788.
Dematteo, D. and Reeves, S., 2011. A critical examination of the role of appreciative inquiry within an interprofessional education initiative. Journal of Interprofessional Care, [e-journal] 25(3), pp.203-208. DOI: 10.3109/13561820.2010.504312.
DiCuccio, M.H., 2015. The Relationship Between Patient Safety Culture and Patient Outcomes: A Systematic Review. Journal of Patient Safety, [e-journal] 11(3), pp.135-142. DOI: 10.1097/pts.000000000000005.
Elo, S. and Kyngas, H., 2008. The qualitative content analysis process. Journal of Advanced Nursing, [e-journal] 62(1), pp.107-115. DOI: 10.1111/j.1365-2648.2007.04569.x.
Enger, R. and Andershed, B., 2018. Nurses’ experience of the transfer of ICU patients to general wards: A great responsibility and a huge challenge. Journal of clinical nursing, [e-journal] 27(1-2), e186-e194. DOI: 10.1111/jocn.13911.
Fencl, J.L. and Willoughby, C., 2019. Daily Organizational Safety Huddles: An Important Pause for Situational Awareness. AORN Journal, [e-journal] 109(1), pp.111-118. DOI: 10.1002/aorn.12571.
Fine, B.A., Golden, B., Hannam, R. and Morra, D., 2009. Leading Lean: a Canadian healthcare leader's guide. Healthcare Quarterly, [e-journal] 12(3), pp.32-41. DOI: 10.12927/hcq.2013.20877.
Foster, S.T., 2004. Managing quality: an integrative approach. Upper Saddle River, N.J.; Great Britain: Prentice Hall.
Gantner, D., Farley, K., Bailey, M., Huckson, S., Hicks, P. and Pilcher, D., 2014. Mortality related to after-hours discharge from intensive care in Australia and New Zealand, 2005–2012. Intensive care medicine, [e-journal] 40(10), pp.1528-1535. DOI: 10.1016/j.physio.2021.01.007.
Graneheim, U.H., Lindgren, B.-M. and Lundman, B., 2017. Methodological challenges in qualitative content analysis: A discussion paper. Nurse education today, [e-journal] 56, pp. 29-34. DOI: 10.1016/j.nedt.2017.06.002.
Häggström, M., Asplund, K. and Kristiansen, L., 2009. Struggle with a gap between intensive care units and general wards. International Journal of Qualitative Studies on Health and Well-being, [e-journal] 4(3), pp.181-192. DOI: 10.1080/17482620903072508.
Häggström, M., Asplund, K. and Kristiansen, L., 2012. How can nurses facilitate patient's transitions from intensive care?: a grounded theory of nursing. Intensive and Critical Care Nursing, [e-journal] 28(4), pp.224-233. DOI: 10.1016/j.iccn.2012.01.002.
Herling, S.F., Brix, H., Andersen, L., Jensen, L.D., Handesten, R., Knudsen, H. and Bove, D.G., 2021. A qualitative study portraying nurses’ perspectives on transitional care between intensive care units and hospitals wards. Scandinavian Journal of Caring Sciences, [e-journal] 36(4), pp.947-956. DOI: 10.1111/scs.12990.
Hollnagel, E., 2014. Is safety a subject for science? Safety Science, [e-journal] 67, pp.21-24. DOI: 10.1016/j.ssci.2013.07.025.
Krueger, R.A., 2014. Focus groups: A practical guide for applied research. Sage publications.
Lagrosen, Y., 2006. Values and practices of quality management: health implications and organisational differences. Doctoral Thesis. Göteborg: Chalmers University of Technology.
Lynch, J., Cope, V. and Murray, M., 2021. The Intensive Care Unit Liaison Nurse and their value in averting clinical deterioration: A qualitative descriptive study. Intensive and Critical Care Nursing, [e-journal] 63, 103001. DOI: 10.1016/j.iccn.2020.103001.
Russell, J.A., 2012. “She's out of the ICU now. “That's a relief, isn't it?”: the growing problem of ICU recidivism. American journal of respiratory and critical care medicine, [e-journal] 185(9), pp.906-908. DOI: 10.1164/rccm.201201-0152ED.
Sammer, C.E., Lykens, K., Singh, K.P., Mains, D.A. and Lackan, N.A., 2010. What is patient safety culture? A review of the literature. Journal of Nursing Scholarship, [e-journal] 42(2), pp.156-165. DOI: 10.1111/j.1547-5069.2009.01330.x.
Seidl, L.K. and Newhouse, P.R., 2012. The Intersection of Evidence-Based Practice With 5 Quality Improvement Methodologies. JONA: The Journal of Nursing Administration, [e-journal] 42(6), pp.299-304. DOI: 10.1097/NNA.0b013e31824ccdc.
Sila, I. and Ebrahimpour, M., 2002. An investigation of the total quality management survey based research published between 1989 and 2000. International Journal of Quality and Reliability Management, [e-journal] 19(7), pp.902-970. DOI: 10.1108/02656710210434801.
Stelfox, H.T., Lane, D., Boyd, J.M., Taylor, S., Perrier, L., Straus, S., Zygun, D. and Zuege, D.J., 2015. A scoping review of patient discharge from intensive care: opportunities and tools to improve care. Chest, [e-journal] 147(2), pp.317-327. DOI: 10.1378/chest.13-2965.
Sten, L., Ingelsson, P., Bäckström, I. and Häggström, M., 2020. Improving ICU transitional care by combining quality management and nursing science - two scientific fields meet in a systematic literature review. International Journal of Quality and Service Sciences, [e-journal] 12(3), pp.385-403. DOI: 10.1108/IJQSS-03-2020-0033.
Sten, L.M., Ingelsson, P., Bäckström, I. and Häggström, M., 2021. Improving Team Collaboration in Patient Transfer Processes by Co-Workers’ Perceptions and Suggestions. Quality Innovation Prosperity, [e-journal] 25(2), pp.1-18. DOI: 10.12776/qip.v25i2.1559.
Tabanejad, Z., Pazokian, M. and Ebadi, A., 2014. A Systematic Review of the Liaison Nurse Role on Patient's Outcomes after Intensive Care Unit Discharge. International journal of community based nursing and midwifery, 2(4), pp.202-210.
Tanjung, H.P. and Nurwahyuni, A., 2019. The Impact of Clinical Pathway Implementation on Length of Stay and Hospital Cost: A Systematic Review. In: ICPH, 6th International Conference on Public Health 2019. Solo, Indonesia, 23-24 October 2019.
Van Sluisveld, N., Hesselink, G., Van der Hoeven, J.G., Westert, G., Wollersheim, H. and Zegers, M., 2015. Improving clinical handover between intensive care unit and general ward professionals at intensive care unit discharge. Intensive care medicine, [e-journal] 41(4), pp.589-604, DOI: 10.1007/s00134-015-3666-8.
Authors
Häggström, M. ., Ingelsson, P., Sten, L.-M., & Bäckström, I. (2023). Success Factors for Quality and Safety of Intensive Care Unit Transitional Care – Listening to the Sharp End. Quality Innovation Prosperity, 27(1), 1–20. https://doi.org/10.12776/qip.v27i1.1789
This work is licensed under a Creative Commons Attribution 4.0 International License.