• Chloe de Grood, LeighJeanna ParsonsJPAlberta Health Services (Stelfox, Bagshaw); W21C Research and Innovation Centre (de Grood), O'Brien Institute for Public Health (Parsons Leigh, Stelfox), Department of Critical Care Medicine (Parsons Leigh, Stelfox, Boyd), and Departm, Sean M Bagshaw, Peter M Dodek, Robert A Fowler, Alan J Forster, Jamie M Boyd, and Henry T Stelfox.
• Alberta Health Services (Stelfox, Bagshaw); W21C Research and Innovation Centre (de Grood), O'Brien Institute for Public Health (Parsons Leigh, Stelfox), Department of Critical Care Medicine (Parsons Leigh, Stelfox, Boyd), and Department of Community Health Sciences (Parsons Leigh, Stelfox, de Grood), University of Calgary, Calgary, Alta.; Department of Critical Care Medicine (Bagshaw), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta.; Division of Critical Care Medicine and Centre for Health Evaluation and Outcome Sciences (Dodek), St. Paul's Hospital and University of British Columbia, Vancouver, BC; Departments of Medicine and Critical Care Medicine (Fowler), Sunnybrook Hospital, University of Toronto, Toronto, Ont.; Department of Medicine (Forster), The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.
• CMAJ. 2018 Jun 4; 190 (22): E669-E676.

BackgroundTransfer of patient care from an intensive care unit (ICU) to a hospital ward is often challenging, high risk and inefficient. We assessed patient and provider perspectives on barriers and facilitators to high-quality transfers and recommendations to improve the transfer process.MethodsWe conducted semistructured interviews of participants from a multicentre prospective cohort study of ICU transfers conducted at 10 hospitals across Canada. We purposively sampled 1 patient, 1 family member of a patient, 1 ICU provider, and 1 ward provider at each of the 8 English-speaking sites. Qualitative content analysis was used to derive themes, subthemes and recommendations.ResultsThe 35 participants described 3 interrelated, overarching themes perceived as barriers or facilitators to high-quality patient transfers: resource availability, communication and institutional culture. Common recommendations suggested to improve ICU transfers included implementing standardized communication tools that streamline provider-provider and provider-patient communication, using multimodal communication to facilitate timely, accurate, durable and mutually reinforcing information transfer; and developing procedures to manage delays in transfer to ensure continuity of care for patients in the ICU waiting for a hospital ward bed.InterpretationPatient and provider perspectives attribute breakdown of ICU-to-ward transfers of care to resource availability, communication and institutional culture. Patients and providers recommend standardized, multimodal communication and transfer procedures to improve quality of care.© 2018 Joule Inc. or its licensors.

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