A Standardized Checklist Improves the Transfer of Stroke Patients from the Neurocritical Care Unit to Hospital Ward

You will notice that I'm sure it is missing the most important question? 

Did you stop the 5 causes of the neuronal cascade of death in the first week?  Accomplished? Not accomplished? Did you calculate how many neurons you allowed to die? My calculation is that my doctors let 

5.4 billion neurons die. 

21,600 miles dead myelinated fibers 

2.8 trillion dead synapses 

Damn hard to recover from all that with no stroke protocols.  

A Standardized Checklist Improves the Transfer of Stroke Patients from the Neurocritical Care Unit to Hospital Ward

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Nick M. Murray, MD, Aditya N. Joshi, MD, Kassi Kronfeld, MD, ...

First Published September 10, 2019 Research Article

https://doi.org/10.1177/1941874419873810

Article information

Abstract

Background and Purpose:

The transfer of patients with ischemic stroke from the intensive care unit (ICU) to noncritical care inpatient wards involves detailed information sharing between care teams. Our local transfer process was not standardized, leading to potential patient risk. We developed and evaluated an “ICU Transfer Checklist” to standardize communication between the neurocritical care team and the stroke ward team.

Methods:

Retrospective review of consecutive patients with ischemic stroke admitted to the neurocritical care unit who were transferred to the stroke ward was used to characterize transfer documentation. A multidisciplinary team developed and implemented an ICU Transfer Checklist that contained a synthesis of the patient’s clinical course, immediate “to-do” action items, and a system-based review of active medical problems. Postintervention checklist utilization was recorded for 8 months, and quality metrics for the postintervention cohort were compared to the preintervention cohort. Providers were surveyed pre- and postintervention to characterize perceived workflow and quality of care.

Results:

Patients before (n = 52) and after (n = 81) ICU Transfer Checklist implementation had similar demographic and clinical characteristics. In the postchecklist implementation period, the ICU Transfer Checklist was used in over 85% of patients and median hospital length of stay (LOS) decreased (8.6 days vs 5.4 days, P = .003), while ICU readmission rate remained low. The checklist was associated with improved perceptions of safety and decreased time needed to transfer patients.

Conclusions:

Use of the standardized ICU Transfer Checklist was associated with decreased hospital LOS and with improvements in providers’ perceptions of patient safety.

Keywords quality improvement, patient handoff, checklist, critical care, stroke, patient safety

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