Improving Patients’ Experience of Transfer from the Adult Intensive Care Unit to the High Dependency Unit

This project started with a question generated when two team members attended a conference, and a presentation they listened to highlighted the importance of planning and good communication when transferring patients out of intensive care. From this, the project question was developed: ‘How can we improve patients’ experience of transfer from our Adult Intensive Care Unit (AICU) to the High Dependency Unit (HDU)?’ This project used an approach called Experience-Based Co-Design (EBCD) to provide a unique opportunity for staff and patients to work together in improving patients’ experiences of the transfer process from the Adult Intensive Care Unit (AICU) to the High Dependency Unit (HDU). The Adult Intensive Care Unit (AICU) is situated in a Specialist NHS Foundation Trust in Central London. The unit has 20 beds and cares for adults who have cardiothoracic illness and require intensive care. The unit has a special interest in patients with cardiac disease and severe lung failure.

The aim of the project was to explore problems for patients and staff with the transfer process, to act on these problems and to implement solutions. Staff and patients were interviewed to capture their experiences and observation sessions of the transfer process were completed and analysed. The service improvement methodology used was Experience-Based Co-Design (EBCD). Twenty-seven staff and seven patients were interviewed. Staff and patients identified main themes to take forward to a joint patient-staff event. Themes included: communication and information for patients and relatives; person-centred care and timing. Following the joint patient-staff event, action planning groups (with patients and staff) worked to implement solutions to improve the communication of doctors and nurses with patients and relatives. The outcomes of the project were positive changes in the delivery of care to patients and their relatives, as highlighted by the evaluation of staff and patients’ experiences of the transfer process. Findings have been fed back to staff and the importance of good communication is continually highlighted. Changes in the way information is communicated have meant that information about the transfer process is clearer for patients and that relatives are more involved in the process. Staff have also gained confidence in capturing patients’ experiences and an annual patient-staff event to evaluate the sustainability of improvements is planned.

The EBCD approach was ideal to explore and improve patient experiences. However, having good role models to facilitate the process was essential. Our team had funding and facilitation from the Foundation of Nursing Studies (FoNS) and Burdett Trust for Nursing ‘Patients First’ initiative which provided invaluable support and learning for the team. Organisational, management, clinical units and project team buy-in was also important. Methods such as ‘Claims, Concerns and Issues’ from practice development theory were also invaluable in improving the team’s confidence and ensured the success of the project.

This project was supported by the Foundation of Nursing Studies Patients First Programme in partnership with the Burdett Trust for Nursing.