Optimizing the safe transition from pediatric intensive care to ward

Centre hospitalier de l’Université de Sainte-Justine


The Challenge

The transition of a patient from the pediatric intensive care unit to the ward is a complex process involving multidisciplinary care teams, administrative support, and the transfer of information, technology, and responsibility for patient care. Discharge from intensive care is a time of increased risk to patients. Intensive care unit readmissions have been associated with increased mortality in adults and children.

The Improvement Project

  1. Analysis and documentation of current transfer process and identify strengths and weaknesses. This will be accomplished by observation of transfers, by multidisciplinary focus groups discussions and interviews to describe the current procedure and to identify perceived risks and strengths, and by objective measures of adverse patient evolution after transfer from the ICU.
  2. Develop a change strategy (handover process and tool) based on evidence from the literature on transitions in other industries and other areas of healthcare, informed by our local needs as described above (1). 
  3. Implement the change strategy, first in our simulation laboratory and then in actual practice.
  4. Evaluate the effect of the change strategy; modify as necessary.
  5. Transfer and maintain knowledge through teaching sessions and ongoing use of the simulation laboratory.
  6. Develop a strategy for process sustainability and ongoing quality monitoring.
  7. Cost-benefit analysis.