Transfer of Patients from the Intensive Care Unit to the Floor

When there is a high patient census, problems with transferring patients from the ICU to the Firm teams have continued to occur.  For that reason, Craig Weinert and I have developed a new policy for this.   Our policy was modified in an effort to provide the highest level of patient-centered care.  For that reason, feedback about this new change is very welcome. 

The ICU Staff physicians have agreed to contact the Firm Staff physicians before 2pm regarding the patients who are ready to be transferred to the floor.  Since residents need to evaluate the patient and write new orders, it is important to make and communicate decisions about transfer early (preferably first thing in the morning).  The firm attending is responsible for acceptance of all patients onto that team.

The Firm teams will assume care for these patients only when the staff-to-staff discussion has occurred.

If the Firm team has accepted a patient ready for transfer to the ward, but no bed is available, the general medicine firm team will change the patient’s status to “boarder” and will rewrite the orders.  In that circumstance, patients whose transfers are delayed must have a new set of orders written on the day of transfer from the ICU to the floor.  (This is a hospital-policy.)If a floor bed is available at night and the ICU really needs an open bed, a stable patient (not yet accepted by the general medicine firm) can be transferred to the floor and will continue to be followed by the ICU Team until the following day when a Firm team can assume care.  

IMPORTANT:  Physicians accepting patients from the ICU must check the box on the Med Rec Form that says they have reviewed the medications!

FIRM TEAM CENSUS CAPS:

• Residents may follow no greater than 16 patients per ward team.
• Long-call firms can accept up to 6 new patients and 2 holdovers or MICU transfers daily.  
• Short-call firms can accept up to 4 new patients
• On rare occasion and only for reason of patient safety, it may occur that these caps are exceeded.  In that circumstance, it is the responsibility both of the resident and the attending to notify the chief residents who will initiate a review with the residency director and appropriate firm director and medical director.

There will certainly be times when scenarios that are not covered here occur.

The first priority is to have the patient cared for by the attending/resident team with the best ability to attend to the patient’s care and needs and with the most rapid availability to care for the patient.

The second priority (closely linked to the first) is to establish absolute clarity with the nursing members of the team (whether in ICU or on the wards) regarding what attending/resident team is responsible for care, how to contact that team, and how to identify and contact cross-cover when the primary team is not available. The Firms website is the best place to determine how to reach the Firm Teams.  That web address is:  http://www.dom.umn.edu/dom/firms.html

The third priority is to minimize the distribution of ward team patients all over the hospital, allowing for the most efficient care of the patients and optimizing communication between members of the healthcare team.