In the early AM, the SICU team solicits opinions and preferences from services regarding discharge suitability, bed planning and preferred destinations. Discharge decisions and destinations ultimately remain the authority of the ICU attending per medical staff bylaws. Anticipated date of transfer (ATD) is listed on the bottom corner of each door and should be updated daily on rounds for accuracy. Before and after rounds, the charge nurse and fellow caucus to determine who, in what order, and where patients can move. To expedite patient flow throughout the hospital, It is expected that the transfer process is completed within 1 hour of a bed being assigned to an ICU patient.
When transferring a patient out of the ICU, the resident must do three things to ensure communication:
- Complete the Epic document for signout, the eCHUGG-OUT, detailed below
- Call the intern on the floor/OU to give a report of the patient’s course. This ensures that there is documentation that checkout occurred, and that goals for a patient’s care are clear.
- Document the sign-out specifics in Epic as an “Event Note” under documents including the time/ date of sign-out and the person who took report AND THE PERSON WHO APPROVED THE TRANSFER (service senior/ fellow/attending). Ensure the MD handoff is appropriately updated.
- REVIEW ALL ORDERS prior to transfer, and make sure any ICU-specific orders are discontinued, as well as any orders that will no longer be needed on the floor.
When the resident/NP is notified that the patient has a bed, they then have the responsibility to call the service pager and perform a medical handoff ensuring the key aspects of patient care are reviewed and discussed as above. Just prior to discharge from the ICU, a critical care fellow (or NP for the NP patients) must personally evaluate the patient to confirm transfer. A Provider Event Note should be placed in the electronic medical record stating to whom you gave sign out. The information in the CHUGG-OUT form must be completed, signed out, and attached.
INDICATIONS FOR DISCHARGE TO THE FLOOR WITH TELEMETRY
Transfers out of the SICU require communication with both an intern (for report) and a senior resident/fellow/attending (for agreement in transfer) on the surgical service. A patient’s readiness for transfer out of the ICU should be assessed daily as part of the Daily Checklist of Unit Guidelines/ Goals (ChUGG) is used for each patient. Also, as part of the preparation for transfer from the ICU, there is a ChUGG OUT form.
When transferring a patient to the 6300 PPCU (PICRU) an additional step of writing a formal transfer note is necessary.
If there is disagreement between the ICU and surgical services regarding disposition (i.e. one wants the patient in the ICU, the other wants the patient in the OU or on the floor), please let the ICU fellow and/or attending know immediately.