Calgary doctor urges rethink on how sickest patients are cared for post-ICU

A national study co-authored by a Calgary doctor is prompting changes to how some of the most critically ill patients and their families are handled during their time in hospital.

The study — published recently in the Canadian Medical Association Journal — looked at what happens when patients are transferred from intensive care to general wards at 10 hospitals in Alberta, British Columbia, Ontario and Quebec.

"We know this is a vulnerable time. There's risk of medical errors. There's a risk of adverse events," said Dr. Tom Stelfox, ICU physician and professor of critical care medicine at the University of Calgary.

Stelfox, who co-authored the study involving 451 cases, says they looked at how doctors, nurses, patients and families all experience the move from ICU to general wards.

Researchers reviewed medical records and conducted surveys. That was followed by one-on-one interviews with 35 patients, family members, physicians and nurses.

"We would hear from patients that they find the move ... to be a frightening experience," said Stelfox.

Difference like 'night and day'

Doreen Rockliff was given a 50-50 chance of surviving when she was rushed to hospital in 2011 with severe sepsis caused by a perforated bowel.

She spent two weeks on life support in the ICU at Foothills hospital before being moved to a general ward.

"When my son said the transition from ICU to general population was like night and day, I think that describes what it was like for my family," said Rockliff, whose family participated in the study.

"After continuing 24-hour care, suddenly there were all these new people that knew nothing about me."

Hopeful yet confusing time

Rockliff's family had come to find comfort in the quiet yet bustling intensive care unit, where they could talk to nurses at any time.

"ICU becomes a place where they're having the best care. The best one-on-one. The highest level of interventions," said Alix Hayden, Rockliff's daughter-in-law.

The relief of moving out of intensive care was punctuated by confusion for the family.

"That's a very hopeful thing to get out … but then you're starting at scratch again," said Hayden, who struggled to get information about her mother-in-law's care plan and condition after the move.

"It's almost like separate hospitals, separate care. There really does need to be a connection to what's going on [and] what to expect," she said.

The gaps are 'everywhere'

The study found these transfers are often "challenging, high-risk and inefficient," and it identifies several problems including communication lapses and the need to better include patients and families in their care.

The communication gaps are "everywhere," according to Stelfox, who saw lapses between the ICU team and the staff taking over care as well as between health-care staff and patients or families.

"[They] feel like that they'd like more time to ask more questions and have a clear understanding of where their care is going before they leave the ICU and go to hospital ward."

The report recommends a number of changes, including standardizing how information is passed on.

Push for change

Change is already in the works in Calgary where, this summer, the city's four adult hospitals will start using a new electronic form to standardize that information flow during ICU transfers.

Stelfox is also pushing for a new way of handling those transitions  It's a system that's been compared to a pit stop in Formula One racing, and it's already being used when patients move from the operating room to intensive care in Calgary.

The idea is that the ICU team meets with the doctors and nurses taking over care in a patient's room — with the family present — at the time of the transfer.

"We review what's happened, what we're doing, what the plan is going forward," he said. "It's a chance for people to ask questions."

Stelfox says hospitals across the country are working on improvements of their own. 

"These are the most vulnerable patients in our health-care system. They're the sickest patients.… So this is a potential opportunity for improving care," said Stelfox.

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