International Journal for Quality in Health Care, 2016, 28(5), 615–625

doi: 10.1093/intqhc/mzw076
Advance Access Publication Date: 17 August 2016
Quality in Practice

Quality in Practice

A multidisciplinary initiative to standardize

intensive care to acute care transitions
STEPHANIE HALVORSON1, BRIAN WHEELER1, MARGE WILLIS1,
JENNIFER WATTERS1,2, JAMIE EASTMAN1, RANDY O’DONNELL1,
and MATTHIAS MERKEL1,3
1
Division of Hospital Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland,
OR, USA, 2Department of Surgery at Oregon Health & Science University, 3303 SW Bond Ave, Portland, OR, USA,
and 3Department of Anesthesiology and Perioperative Medicine at Oregon Health & Science University,
3181 S.W. Sam Jackson Park Road, Portland, OR, USA

Address reprint requests to: Brian A. Wheeler, Division of Hospital Medicine, Oregon Health & Science University,
3181 SW Sam Jackson Park Road, Portland, OR 97239, USA. Tel: +1-503-418-0464; Fax: +1-503-494-1159;
E-mail: wheelerb@ohsu.edu
Accepted 15 June 2016

Abstract
Quality issue: Transfers from intensive care units to acute care units represent a complex care
transition for hospitalized patients. Within our institution, variation in transfer practices resulted in
unpredictable processes in which patient safety concerns were raised.
Initial assessment: Key stakeholders were engaged across the institution. Patient safety (’incident’)
reports and a staff survey identified safety concerns.
Choice of a solution: Using lean methodology, current transfer processes were mapped for the
four adult intensive care units and waste was identified. During a summit of key stakeholders an
ideal transfer process was conceived and a structured handoff tool (checklist) was developed. A
daily management system (DMS) was implemented to monitor adherence.
Evaluation: The primary process outcome was adherence to the standardized workflow. Audits at
4, 8, and 12 months after implementation indicated that the checklist was used for 100% of trans-
fers. Secondary outcomes included the percentage of transfers completed within a pre-specified
time window of 120 minutes, provider notification of patient arrival on the acute care unit, and
staff survey responses assessing adequacy of transfer communication.
Lessons learned: Prior work has shown that structuring handoffs can improve patient safety, but the
novelty of this project was addressing the transfer process in its entirety, across silos of care. Factors
leading to the success of this project were the involvement of key stakeholders across the entire insti-
tution early in the project development phase, employment of lean methodology, and implementation
of tools to guide workflow adherence and track causes of deviation from the workflow.

Key words: quality improvement, checklist, lean management, process mapping, safety culture

Introduction patient handoff as ‘the transfer of information and professional

Patient transfers between intensive care (ICU) and acute care units responsibility and accountability between individuals and teams,
(ACU) are common care transitions for hospitalized patients and are within the overall system of care’ [1]. Patient handoffs have been
often accompanied by a ‘handoff’ in care. Jeffcott et al. define a shown to present opportunities for communication failures and

© The Author 2016. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved.
For permissions, please e-mail: journals.permissions@oup.com 615

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 616
errors and therefore may compromise patient safety [2–5]. Existing
literature indicates that the content and structure of transfer commu-
nications is vital to patient safety [6–12]. For example, implementa-
tion of handoff checklists have been shown to be beneficial in
ensuring transfer of critical information for patient handoffs in the
perioperative period, at shift change, and at hospital discharge [13–
15]. ICU to ACU handoffs are particularly complex. In addition to
the need for verbal handoff between key providers (nurse-nurse,
provider-provider, team-patient), patients often change entire service
lines in which variable administrative and workflow patterns may
exist [16–21]. While quality improvement efforts have targeted the
verbal and written components of patient handoffs, little is written
about standardizing the entire complex process of a patient handoff,
including all impacted providers and services [22].
Quality issue
Within our institution, variation in workflow for patients transfer-
ring from ICUs to ACUs was common. Each adult ICU within our
healthcare system had a unique, non-standard transfer process in
place. For example, patients transferring from the Medical ICU
(MICU) to a medical ACU underwent a different series of transfer
steps than patients transferring from the Trauma Surgery ICU
(TSICU) to a surgical ACU. Even within a single service line, expec-
tations for provider handoff communication were not always clear
or uniform. Additionally, there was variability in patient transporta-
tion and room turnover time that led to a high degree of unpredict-
ability of the process, with cases of verbal handovers occurring
many hours (or even an entire day) prior to the actual patient trans-
fer due to delays in bed availability. Furthermore, on more than one
occasion, patients were transferred out of an ICU without notifica-
tion of the intended receiving team, resulting in prolonged periods
of time during which patients did not have an identifiable responsible
provider. Patient safety (‘incident’) reports identified opportunities in
which patients were at risk of harm due to these delays in transfer,
omissions of key transfer tasks, and communication failures. Root
cause analyses of these incidents identified a lack of standardized pro-
cesses for patient transfers from ICUs to ACUs as a factor contribut-
ing to potential risk of patient harm, as well as a large amount of
inefficiency in our system.
In response to these safety concerns, we embarked on a quality
improvement project to standardize the transfer process and thereby
improve the predictability and timeliness of transfers from adult ICUs
to ACUs. In this paper, we describe the successful development and
implementation of a standardized workflow and structured handoff
checklist for ICU to ACU transfers across our complex hospital system.
Initial assessment
Context
Our institution is a 550-bed academic, tertiary care center with
13 medical and surgical ACUs and 80 adult critical care beds across
four adult ICUs (MICU, TSICU, Neuroscience ICU or NSICU, and
Cardiac-Surgical ICU or CSICU). Each of the 4 ICUs has a designated
ICU team under the direction of a critical care trained attending phys-
ician with house officers and, in 3 out of 4 teams, advanced practice
providers (NSICU, TSICU, CSICU). Patients are either managed exclu-
sively by the ICU team (i.e. a ‘closed’ ICU model), or are co-managed
with the admitting service (i.e. a ‘semi-open’ ICU model), but ordering
privileges reside with the ICU team only on all units. Patients transfer-
ring from the ICU to an ACU are then either handed off from the ICU
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Wheeler et al.
provider team to a different provider team entirely (e.g. in the “closed”
model) or back to the team with whom they had been co-managed in
the ICU. Nursing coverage throughout our institution is unit-based.
In 2010 our institution adopted ‘Lean’ methodology as a means
for improving quality and safety within our healthcare system. Lean
is a set of principles adopted from the Japanese auto industry that
emphasize reducing waste within a system [23].
Institutional review board
Institutional review board exemption was granted for analysis and
publication of this quality improvement project.
Planning the intervention
A steering committee was formed with representation from ICU,
ACU, supportive services, and quality management personnel, and
was endorsed by senior hospital leadership. A needs assessment was
performed by conducting an anonymous survey of physicians, house
officers, and nursing staff in order to determine opportunities for
improvement in the transfer process. The results of this survey,
along with patient safety reports, served as a framework to guide
design of a new ICU transfer process.
A one-day summit was held involving approximately 40 key sta-
keholders including physicians, house officers, nursing staff, and
pharmacists, as well as representatives from transportation services,
environmental services, and bed flow management. Participants
mapped the existing process of patient transfer from ICU to ACU
using a swim lane flowchart for each of the four adult ICUs (see
Supplementary Appendices 1–4). Lean methodology was employed
to perform an analysis waste and opportunities for standardization,
as shown in Table 1.
Choice of solution
Summit participants identified an ‘ideal state’ outlining the key steps
required for a safe patient transfer and then assigned accountability
for each step. Participants then created a structured handoff tool
(see Supplementary Appendix 5) to direct the transfer process.
Participants elected to use a paper checklist, rather than an elec-
tronic one, as it allowed for person-to-person communication and
was felt to be a more immediate reminder to complete a task.
Multiple decisions were made to address specific forms of waste,
examples of which are listed in Table 1.
Time was identified as a critical element in standardizing expec-
tations and predictability of the transfer process. After reviewing
baseline data, summit participants determined that a transfer should
be completed within 120 min. The starting point, or ‘time zero’ for
the process, was defined as ‘ACU bed vacant’ and the end time was
defined as ‘patient arrival in the ACU’. The checklist allowed docu-
mentation of the time at which each step was completed in order to
audit and address any time delays.
In order to facilitate closed-loop communication and ensure
completion of the required steps in the transfer process, summit par-
ticipants determined that the checklist would remain with the
patient upon transfer to the receiving unit for completion the final
steps. Finally, it would be faxed back to the ICU.
Implementation
The final standardized workflow for patient transfers from ICUs to
ACUs is shown in Fig. 1. In the current system, the ICU charge
 Standard ICU to ACU transitions • Quality Assessment 617

Table 1 Examples and descriptions of types of waste identified during stakeholder summit

Lean waste type Description Role Example

Transportation Unnecessary movement of patients, Pharmacy Medications sent to wrong unit and required transport
specimens, materials within the dispatch for redirection.
system.
Inventory Excess inventory, storage and Pharmacy Time sensitive medications sent to wrong location
movement costs, spoilage, during patient transfer, required medication disposal
wastage. and new medication preparation.
Motion Unnecessary movement by Nursing Transportation Patient transferred to acute ward without personal
employees in the system. belongings. Additional transportation resources
dispatched to obtain and transport patient
belongings.
Waiting Waiting for the next event or activity Physician Delay in completion of transfer orders when acute care
to occur. bed available.
Nursing Accepting nurse not available for verbal handoff due to
clinical care responsibilities. Transfer delayed
pending nurse verbal handoff.
Over processing or Doing work that does not add value. Environmental services Daily cleaning of patient rooms when patient planned
incorrect processing for discharge the same day.
Overproduction Doing more than what is needed, or Bed flow Bed assignment occurred before special needs identified
doing it sooner than needed. (isolation, telemetry, etc.).
Defects Time spend doing something Transportation Transportation arrived with incorrect or unnecessary
incorrectly, inspecting for errors, equipment.
or fixing errors.
Human potential Waste due to not engaging Environmental services Excessive staff available during morning hours when
employees. not needed and insufficient staff available during
afternoon hours when most post discharge room
turnover occurs.

nurse is notified that an ACU bed is vacant and initiates the transfer
process using the structured checklist. Once all items are complete
and verified on the checklist, the patient is transported to the ACU
accompanied by the checklist. The ACU nurse is responsible for
completion of the final steps including the final one; notification of
the receiving provider team that their patient has arrived on the
ACU. Once completed, checklists are returned to the ICU where
data are reviewed and recorded.
Prior to hospital-wide implementation, this workflow was
piloted on two intensive care units (MICU and CSICU) during a
two-month period. After minor modifications, the process was sub-
sequently implemented in all four adult ICUs.
A daily management system (DMS) was implemented to facili-
tate tracking and review of deviations from the standardized work-
flow in real time. During the 12-month study period, the DMS
consisted of a daily audit in each ICU of the prior day’s checklists to
confirm completion of required process steps, identify delays in
transfer completion, and analyze deviations from the standardized
workflow. Delays and deviations were categorized and shared dur-
ing daily huddles, and displayed on individual unit performance bul-
letin boards. Delays and process deviations were categorized by type
(i.e. transportation, nursing, provider, etc.) and were referred to sub-
committees for further review.
The DMS revealed that common reasons for delays in transfer
were related to transportation availability, environmental services
workload, and delays in nursing handoff communications. The com-
mittee then worked with the individual service managers to resolve
any observed defects in the process by deploying rapid cycle process
improvement methodology. To address the issue of nursing handoff,
a second summit was convened to create a workflow for reliable
nurse-to-nurse handoff. The outcome was a ‘pull’ system in which
the ACU nurse is notified of an incoming transfer, and has a
specified time period in which to call to receive sign-out. This system
allows the ACU nurse the flexibility to prioritize other tasks before
receiving sign-out.
Evaluation
During the 12-month period of evaluation, the primary process out-
come was adherence to the standardized workflow, represented by
the completion of the checklist for all ICU to ACU transfers. Audits
of adherence were performed at 4-month intervals. Secondary out-
comes of this study were the average time to transfer completion,
the percentage of transfers completed within the target window of
120 min, the percentage of transfers in which the receiving provider
was notified of patient arrival onto the ACU (as measured by check-
list completion for that item), and staff survey responses assessing
adequacy of transfer communication.
Time to transfer completion, before and after implementation of
the standardized workflow, was analyzed using the Kruskal-Wallis
one-way analysis of variance. Proportions of patients with com-
pleted transfers in <120 and <150 min and survey results were com-
pared using a test of two proportions. All statistical analysis was
carried out using Stata 13.0 (StataCorp. 2013. Stata Statistical
Software: Release 13. College Station, TX: StataCorp LP).
Findings
Approximately 600 person-hours were invested during the develop-
ment of this process and the 1-year period of evaluation. The pri-
mary outcome of adherence to the standard workflow was
measured by the percentage of total ICU to ACU transfers (denom-
inator) in which a completed checklist was received by the ICU
(numerator). Audits conducted at 4, 8, and 12 months after

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 618 Wheeler et al.

Table 2 Proportion of patients transferred in <120 min and

<150 min before and after implementation of a standardized
transfer workflow

Assume patient care and

Time Period <120 min <150 min
n(%) n(%)

Evaluate patient
Baseline (n = 91) 43 (47.25) 61 (67.03)

release orders

review orders
Month 4 (n = 50) 31 (62.00) 39 (78.00)

return to ICU charge RN

Post transfer window

Complete checklist and

Month 8 (n = 66) 43 (65.15)a 59 (89.39)a
Month 12 (n = 77) 50 (64.94)a 63 (81.82)a

a
Statistically significant (P < 0.05) from baseline.

Notify receiving provider

Update system with

implementation demonstrated 100% adherence to the standar-

of patient arrival
patient location

dized workflow.

Figure 1 Swim lane chart depicting multidisciplinary roles and responsibilities in the transfer process. ICU, intensive care unit; ACU, acute care unit; RN, registered nurse.
Transport

The percentage of patient transfers occurring within the target

patient

of 120 min during the study period is shown in Table 2. Overall

there was an increase in the number of patients transferred within
Provider Verbal Handover

Provider Verbal Handover

120 min over the study period, with statistically significant differ-
transport
Dispatch
Transfer window (120 min) – begins with vacant bed signal (dirty or clean)

ences observed at 8 months (P = 0.0261) and 12 months

RN Verbal Handover

RN Verbal Handover
Bed room ready for

(P = 0.0216), but not at four months (P = 0.0934) after implemen-

tation. Subsequent analysis revealed that there was also a signifi-
occupancy

cant increase in the proportion of patients transferred within

150 min, as shown in Table 2.
Transport reserved

The variation in time to transfer, a metric of predictability of

the system, was also decreased as evidenced by a narrower stand-
Preschedule transport

ard deviation (Fig. 2). During the study period, inpatient bed occu-
Notify patient & family of transfer

pancy ranged from 94% to 98% in the ACUs and 73–84% in the
Collect medications & supplies
Complete transfer summary

ICUs, with no statistically significant differences in occupancy

Notify pharmacy of transfer
Collect patient belongings
Complete transfer orders

volume.
ACU provider notification improved from 34/50 (68%) at
baseline to 46/51 (90.2%), 168/172 (91%), 77/85 (90.6%) at 4, 8,
Clean room/bed

and 12 months, respectively.

A brief electronic survey was sent to faculty and residents in
the departments of medicine and surgery and to nursing from the
Initiate checklist

ICUs and ACUs. Around 158 and 166 individuals responded to

the pre- and post-survey, respectively (total number of recipients
not tracked, as such response rate not calculated). These were
comprised of 41 physicians (resident and faculty), 2 physician
Vacant Bed (Time Zero) assistants, and 115 nurses in the pre-survey, and 43 physicians
and 123 nurses in the post-survey. Survey responses, shown in
Table 3, indicate a significant improvement in perceptions of the
Assign room/bed

adequacy of transfer communication, clarity regarding the pro-

vider in charge of the patients’ care, and perceptions of timely
Pre-transfer window

evaluation by a provider after arrival on the ACU, with no change

Request room/bed

in the perceived communication to the patient that they would be

transferring.
Decision to transfer patient

Discussion and lessons learned

In this paper, we describe the development and implementation of
a standardized process for all adult ICU to ACU transfers within
the complex environment of an academic medical center. The
results indicate that we were able to bridge different practice mod-
ICU Charge RN

Acute Care RN
Transportation

Environmental

ICU Provider

els and cultures and successfully employ a standard workflow for

Acute Care

Acute Care
Charge RN
Role

Bed Flow
Manager
Services

all ICU to ACU transfers. While we did not meet our goal of trans-
Provider
ICU RN

fer within 120 min for all patients, the increase in transfers occur-
ring within this timeframe suggests that we are trending toward
improved transfer efficiency. Furthermore, over 80% of transfers
occurred within 150 min, and the variability in transfer times
decreased, thereby adding predictability to the process.

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 Standard ICU to ACU transitions • Quality Assessment
Frequency of provider notification of patient arrival to the ACU
improved significantly following implementation of the standard
workflow and was sustained over the study period. Staff survey
responses indicate that these changes have resulted in improved
communication and transparency of the transfer process. Together
these data suggest that we are achieving standard compliance and
moving closer to a culture of safety.
Prior work has shown that patient handoffs present opportunities
for errors, care omissions, treatment delays, duplication of tests, ineffi-
ciencies, and adverse events, and many strategies have been employed
to improve handoffs in different care settings [2, 5, 6, 13–15, 24–26].
A review of postoperative handoff literature identified 12 strategies for
safe and effective postoperative handoffs, and emphasized the import-
ance of protocols and standardization [13]. Similarly, structured pro-
cesses and checklist-guided communication have been shown to
improve completeness of transmitted information at the time of ICU
transfer, a complex patient handoff that involves almost all inpatient
care services. The novelty of our approach is to address the transfer
process in its entirety across all ICU-ACU transfers, regardless of med-
ical or surgical subspecialty.
Following adoption of Lean methodology, our institution suc-
cessfully employed Lean tools to improve this process. Lean, the
“Toyota way of thinking” as described by Liker [23], has been
adopted to help achieve sustainable improvement in quality and cost
reduction through elimination of waste, defined as non-value adding
Figure 2. Median time for an ICU to ACU transfer at baseline and 4, 8 and 12
months after implementation of a standardized transfer workflow. In this box
and whisker plot the horizontal line represents the median transfer time in
minutes. The surrounding box represents one standard deviation around the
median. A smaller box represents less variation. ICU, intensive care unit;
ACU, acute care unit.
Table 3. Proportion of survey respondents indicating ’agree’ or ’strongly agree’ with statements before and after implementation of a
standardized transfer workflow.
Question
Information needed to care for the patient is clearly communicated (e.g. SBAR).
The patient was informed of the transition from Critical Care to Acute Care (e.g. staffing ratios).
The accepting MD/provider name was clearly identified in the chart and/or verbal communication.
The accepting MD/provider is always notified that the patient has arrived on the acute care unit.
The accepting MD/provider sees the patient within 30 minutes of arrival on the acute care unit.
a
Statistically significant (P < 0.05) from baseline.
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619
process steps, in a multitude of settings, including healthcare
[27–32]. A fundamental principles of Lean is the creation of stan-
dards that are rigid and accurately followed, while allowing for the
standard to be re-evaluated and rapidly modified [33]. This dynamic
improvement process applies to more than just tools and techniques;
it requires each member of a complex team to take ownership of the
process. DMS, a Lean tool, was critical in quickly identifying and
addressing problems, and regular stakeholder meetings allowed for
rapid modification of the standard work and tools to ensure
ongoing momentum and accountability for this project.
Further keys to success of this project include involvement of
critical stakeholders across the entire institution early in the project
development phase, widespread use of Lean methodology, and
development of tools to guide workflow adherence and monitor
deviation from the workflow. Adoption of a transfer checklist to
drive standard workflow was integral in changing the culture in a
large and diverse academic institution.
The new workflow has allowed for additional unintended bene-
fits as well. Previously, patients awaiting transfer to acute care teams
were not assigned until physical arrival on the ACUs. With
improved predictability of transfer, we are now able to maximize
daytime admitting capacity by assigning patients to an ACU treat-
ment team as soon as verbal handover is performed, allowing receiv-
ing teams to begin preparing to care for patients knowing that they
are likely to arrive within 120 minutes. As such, standardization has
allowed for other innovation and improvements in patient flow. No
unintended negative consequences were observed following imple-
mentation of the new standard work.
While the benefit of process standardization for ICU to acute
care transfers may have greater impact in large tertiary centers with
multiple subspecialty ICUs and care teams, this study may be used
as a framework by institutions of all sizes given the complexity of
multidisciplinary care that exists in all healthcare facilities, particu-
larly as it relates to transfers of patient care. Regardless of size,
many institutions remain challenged by the need to optimize patient
flow, and improving efficiency of ICU to acute care handovers
through development of standard work represents an opportunity to
eliminate waste.
There are several limitations to this work and its generalizability.
This workflow was designed to address local problems, thus the
quality improvement needs at our institution may be unique and
solutions may not translate easily to another setting. However, our
ability to employ lean principles, identify waste, and standardize a
process across a wide range of different inpatient settings and cul-
tures are tools that can be applied elsewhere. Additionally, while we
describe the development of a new workflow and evidence that it
has been successfully implemented, we did not study the gold stand-
ard outcome, which is an improvement in patient safety and fewer
Before After P-value
n(%) n(%)
140/165 (84.85) 149/157 (94.90) 0.0029a
131/162 (80.86) 128/156 (82.05) 0.7854
77/156 (49.36) 107/154 (69.48) 0.0003a
78/135 (57.78) 97/125 (77.60) 0.0004a
41/130 (31.54) 53/113 (46.90) 0.0142a
 620
‘near misses.’ That said, our anecdotal experience and staff surveys
suggest that this work is helping us move towards a culture of
safety. Similarly, while standardized handoffs have been shown to
have a positive impact on many factors including clinician perform-
ance (e.g. better communication, fewer omissions), patient out-
comes, and patient satisfaction, the relationship between improved
handoffs and patient safety has not been clearly established
[1, 2, 34, 35].
Another important limitation is that we did not address avail-
ability of acute care beds in this project. Availability is variable and
depends on overall occupancy, discharge timeliness, and other fac-
tors felt to be outside the scope of this project. This project, there-
fore, addressed the period between ACU bed availability and
subsequent transfer, but did not examine delays in overall bed avail-
ability. Importantly, hospital occupancy remained stable during this
period suggesting that the improvements were not simply due to an
increase in bed availability.
In summary, transfer from an ICU to ACU marks a critical
transition period in which many complex tasks must be reliably per-
formed, and critical patient-specific information must be communi-
cated between provider teams. Quality and patient safety may be
adversely affected if critical steps are not performed, and a lack of
standardization can result in waste in the system. We have success-
fully managed to implement and dynamically improve a new stan-
dardized workflow for transferring adult patients from the ICU
to ACU.
Acknowledgments
The authors wish to thank the OHSU hospital leadership team and clinical
and department leaders for their support of this project. We also wish to
thank the numerous team members who made this project possible. This
includes, but is not limited to: Nursing staff, physicians and advanced
practice providers, pharmacy services, environmental services, transporta-
tion services, bed control management the house officers, and quality
management.
Funding
This was an unfunded quality improvement project.
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Appendix 1: Pre intervention medical ICU transfer workflow.

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Appendix 2: Pre intervention cardiac/surgical ICU transfer workflow.

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 Standard ICU to ACU transitions • Quality Assessment 623

Appendix 3: Pre intervention trauma ICU transfer workflow

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 624 Wheeler et al.

Appendix 4: Pre intervention neurosciences ICU transfer workflow.

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 Standard ICU to ACU transitions • Quality Assessment 625

ICU to ACU Patient Handover Checklist

Sending Unit Date: ______ /_______/_______

 TSICU fax#
ICU Charge RN:____________
 NSICU fax# Patient Label
 CSICU fax# ICU Bedside RN:____________
 MICU fax#

Owner Transfer Task Initials Barriers/delays

 Bed assignment conirmed by charge RN:
Time bed vacant: __________________
Unit: ____________________
ICU Charge

Room/Bed: _________________
 Transportation prescheduled
Time: _____________ (90 min or less from time bed vacant)
 Epic MAR In-basket note to pharmacy
 ACU RN paged (patient name, transfer time, ICU RN name, phone extension)
Time: _____________
A. For patients CHANGING service lines:
Receiving team: ________________________________
Receiving provider: _______________________________
_ Pager: _________

Provider

Transfer orders reconciled in Epic

 Report called to receiving provider
Time report called : ________________
Sending provider name (print): _________________________________________
Sending provider signature: ____________________________________________

B. For patients REMAINING within service line:

 ICU Provider paged with notiication of transfer destination
ICU provider name: ________________________________ Pager: _________
Time notiied: _________________
 Transfer orders reconciled in Epic
Patient and family notiication
 Patient & Family notiied of transfer
 Transfer of Care information sheet provided
Nursing handoff note
 RN handoff note completed
Nursing verbal report
 Nursing Report Called
ICU RN

ACU RN receiving report: _______________________________

Time report called: ______________________________________
ICU RN signature: ________________________________________
Patient belongings
 Patient belongings list reviewed and veriied
 All belongings gathered and prepared for transfer
Medications & supplies
 Medications placed in clear plastic back, labeled, and secured in bedside
chart
 Supplies including tube feedings and tracheostomy articles gathered and
prepa red for transfer
Transportation
Scheduled arrival time: _____________
Actual arrival time: _______________
Time of patient arrival on ACU: ____________________
 Receiving team notiied of patient arrival and location
Unit Coordinator
ACU Nurse /

Method of notiication (circle): Face to face Paged

Receiving provider name : __________________________ Pager: __________

Receiving nurse signature : _________________________________________________

 Checklist returned to transferring unit

Appendix 5.

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