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Henry T. Stelfox - One of the best experts on this subject based on the ideXlab platform.
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Identifying essential elements to include in Intensive Care Unit to Hospital Ward transfer summaries: A consensus methodology.
Journal of critical care, 2018Co-Authors: Icu Transfer Summary Consensus Panel, Chloe De Grood, Christiane N. Job Mcintosh, Jamie M. Boyd, Karolina Zjadewicz, Jeanna Parsons Leigh, Henry T. StelfoxAbstract:Abstract Purpose Transitions of care from the intensive care unit (ICU) to a Hospital Ward are high risk and contingent on effective communication. We sought to identify essential information elements to be included in an ICU to Hospital Ward transfer summary tool, and describe tool functionality and composition perceived to be important. Materials and methods A panel of 13 clinicians representing ICU and Hospital Ward providers used a modified Delphi process to iteratively review and rate unique information elements identified from existing ICU transfer tools through three rounds of review (two remote and one in person). Qualitative content analysis was conducted on transcribed audio recordings of the workshop to characterize tool functionality and composition. Results A total of 141 unique information elements were reviewed of which 63 were identified by panelists as essential. Qualitative content analyses of panelist discussions identified three themes related to how information elements should be considered when developing an ICU transfer summary tool: 1) Flexibility, 2) Usability, and 3) Accountability. Conclusion We identified 63 distinct information elements identified as essential for inclusion in an ICU transfer summary tool to facilitate communication between providers during the transition of patient care from the ICU to a Hospital Ward.
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patient family and provider experiences with transfers from intensive care unit to Hospital Ward a multicentre qualitative study
Canadian Medical Association Journal, 2018Co-Authors: Chloe De Grood, Jamie M. Boyd, Jeanna Parsons Leigh, Sean M Bagshaw, Peter Dodek, Robert A Fowler, Alan J Forster, Henry T. StelfoxAbstract:BACKGROUND: Transfer 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. METHODS: We 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. RESULTS: The 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. INTERPRETATION: Patient 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.
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a multi center prospective cohort study of patient transfers from the intensive care unit to the Hospital Ward
Intensive Care Medicine, 2017Co-Authors: Henry T. Stelfox, Jeanna Parsons Leigh, Andrea Soo, Peter Dodek, Alan J Forster, Alexis F Turgeon, Francois Lamontagne, Rob Fowler, Sean M BagshawAbstract:To provide a 360-degree description of ICU-to-Ward transfers. Prospective cohort study of 451 adults transferred from a medical–surgical ICU to a Hospital Ward in 10 Canadian Hospitals July 2014–January 2016. Transfer processes documented in the medical record. Patient (or delegate) and provider (ICU/Ward physician/nurse) perspectives solicited by survey 24–72 h after transfer. Medical records (100%) and survey responses (ICU physicians–80%, ICU nurses–80%, Ward physicians–46%, Ward nurses–64%, patients–74%) were available for most transfers. The median time from initiation to completion of transfer was 25 h (IQR 6–52). ICU physicians and nurses reported communicating with counterparts via telephone (78 and 75%) when transfer was requested (82 and 24%) or accepted (31 and 59%) and providing more elements of clinical information than Ward physicians (mean 4.7 vs. 3.9, p < 0.001) and nurses (5.0 vs. 4.4, p < 0.001) reported receiving. Patients were more likely to report satisfaction with the transfer when they received more information (OR 1.32, 95% CI 1.18–1.48), had their questions addressed (OR 3.96, 95% CI 1.33–11.84), met the Ward physician prior to transfer (OR 4.61, 95% CI 2.90–7.33), and were assessed by a nurse within 1 h of Ward arrival (OR 4.70, 95% CI 2.29–9.66). Recommendations for improvement included having a documented care plan travel with the patient (all stakeholders), standardized face-to-face handover (physicians), avoiding transfers at shift change (nurses) and informing patients about pending transfers in advance (patients). ICU-to-Ward transfers are characterized by failures of patient flow and communication; experienced differently by patients, ICU/Ward physicians and nurses, with distinct suggestions for improvement.
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Prospective cohort study protocol to describe the transfer of patients from intensive care units to Hospital Wards.
BMJ open, 2015Co-Authors: Denise Buchner, Sean M Bagshaw, Peter Dodek, Robert A Fowler, Alan J Forster, Alexis F Turgeon, Francois Lamontagne, Melissa L. Potestio, Henry T. StelfoxAbstract:Introduction The transfer of patient care between the intensive care unit (ICU) and the Hospital Ward is associated with increased risk of medical error and adverse events. This study will describe patient transfer from ICU to Hospital Ward by documenting (1) patient, family and provider experiences related to ICU transfer, (2) communication between stakeholders involved in ICU transfer, (3) adverse events that follow ICU transfer and (4) opportunities to improve ICU to Hospital Ward transfer. Methods This is a mixed methods prospective observational study of ICU to Hospital Ward transfer practices in 10 ICUs across Canada. We will recruit 50 patients at each site (n=500) who are transferred from ICU to Hospital Ward, and distribute surveys to enrolled patients, family members, and healthcare providers (ICU and Ward physicians and nurses) after patient transfer. A random sample of 6 consenting study participants (patients, family members, healthcare providers) from each study site (n=60) will be offered an opportunity to participate in interviews to further describe stakeholders’ experience with ICU to Hospital Ward transfer. We will abstract information from patient health records to identify clinical data and use of transfer tools, and identify adverse events that are related to the transfer. Ethics and Dissemination Research ethics board approval has been obtained at the coordinating study centre (UofC REB13-0021) and 5 study sites (UofA Pro00050646; UBC-PHC H14-01667; Sunnybrook 336-2014; QCH 14-07; Sherbrooke 14-172). Dissemination of the findings will provide a comprehensive description of transfer from ICU to Hospital Ward in Canada including the uptake of validated or local transfer tools, a conceptual framework of the experiences and needs of stakeholders in the ICU transfer process, a summary of adverse events experienced by patients after transfer from ICU to Hospital Ward, and opportunities to guide quality improvement efforts.
Hua Qian - One of the best experts on this subject based on the ideXlab platform.
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spatial distribution of infection risk of sars transmission in a Hospital Ward
Building and Environment, 2009Co-Authors: Hua Qian, Peter V Nielsen, Xinhua HuangAbstract:Abstract The classical Wells–Riley model for predicting risk of airborne transmission of diseases assumes a uniform spatial distribution of the infected cases in an enclosed space. A new mathematical model is developed here for predicting the spatial distribution of infection risk of airborne transmitted diseases by integrating the Wells–Riley equation into computational fluid dynamics. We applied our new integrated model to analyze a large nosocomial SARS outbreak in Hong Kong during the 2003 SARS epidemics, which was studied in the literature with regard to the association between airflow and SARS infection. The predicted numbers of infected cases of medical students in the same cubicle, the adjacent cubicle and the distant cubicle were 6.39, 0.78 and 0.2 respectively while the observed numbers of infected medical students in the three cubicles were 7, 0 and 0 respectively during the morning of March 6th, which was the highest attack period. The predicted numbers of infected cases of inpatients during the morning of March 6th in the same cubicle, the adjacent cubic and the distance cubicle were 7.8, 5.1, and 4.8 respectively which also agree well with the observed distribution of the infected inpatients during the entire infection period. The new developed model provides a new modelling tool for investigating the airborne transmission of diseases in enclosed spaces. The model is applicable when the susceptible stays mostly at the same location in an enclosed space during the infectious period, such as inpatients in a Hospital Ward, passengers in an airplane etc.
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dispersion of exhalation pollutants in a two bed Hospital Ward with a downWard ventilation system
Building and Environment, 2008Co-Authors: Hua Qian, Peter V Nielsen, Carl Erik HyldgaardAbstract:Abstract The Centers for Disease Control and Prevention has recommended the use of downWard ventilation systems in isolation rooms to reduce the risk of cross-infection from airborne transmissible diseases. The expected airflow pattern of a downWard ventilation design would supply cooler and slightly heavier clean air from a ceiling diffuser to push down contaminants, which would then be removed via outlets at floor level. A “laminar” (strictly speaking, unidirectional) flow is expected to be produced to avoid flow mixing and thus reduce cross-infection risk. Experiments were carried out in a full-scale experimental Hospital Ward with a downWard ventilation system to investigate the possibility of applying downWard ventilation in a general Hospital Ward. Two life-sized breathing thermal manikins were used to simulate a source patient and a receiving patient. Computation fluid dynamics was also used to investigate the airflow pattern and pollutant dispersion in the test Ward. Based on both experimental and numerical results, the laminar airflow pattern was shown to be impossible to achieve due to turbulent flow mixing and flow entrainment into the supply air stream. The thermal plumes produced above people were found to induce flow mixing. We also studied the effects of the locations of the supply and extraction openings on both the flow pattern and pollutant exposure level in the occupied zone. A number of practical recommendations are suggested.
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dispersion of exhaled droplet nuclei in a two bed Hospital Ward with three different ventilation systems
Indoor Air, 2006Co-Authors: Hua Qian, Peter V Nielsen, Carl Erik Hyldgaard, Tze Wai Wong, A T Y ChwangAbstract:UNLABELLED Effective ventilation in general Hospital Wards is important for controlling the airborne transmission of infectious respiratory diseases. Experiments have been carried out to increase our understanding of the interaction of the breathing flows of two individuals in a full-scale experimental Hospital Ward with three ventilation systems, i.e. mixing, downWard and displacement ventilation. Two life-size breathing thermal manikins were used to simulate a source patient and a receiving patient. The exhalation jet from a bed-lying manikin was visualized using smoke. N2O was used as tracer gas to simulate the droplet nuclei exhaled by patients; and the spatial distribution of its concentrations was measured. Our experimental results show that for both mixing and downWard ventilation, the exhaled jet penetrates a short distance and is diluted quickly by ventilation air. The exhaled droplet nuclei are well mixed in the Ward. Bed distance does not affect the personal exposure of the receiving patient. For displacement ventilation, the exhaled jet can penetrate a long distance. A high concentration layer of exhaled droplet nuclei because of thermal stratification locking has also been observed with displacement ventilation. This work is useful for identifying an appropriate ventilation method that can remove droplet nuclei more effectively and minimize the risk of cross-infections in a Hospital Ward environment. PRACTICAL IMPLICATIONS As one of the major potential sources for infectious droplet nuclei in a Hospital environment, exhalation flows of an infected patient can interact with the respiratory activities of other close individuals and with the room ventilation systems. Our latest results provide information on the penetration of exhalation jets into the ambient environment in different ventilation systems. This work is useful in identifying an appropriate and effective ventilation method for removing droplet nuclei more effectively, and thus minimizing the risk of cross-infections in Hospital Wards with multiple beds.
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role of air distribution in sars transmission during the largest nosocomial outbreak in hong kong
Indoor Air, 2005Co-Authors: Xinli Huang, Tze Wai Wong, Hua QianAbstract:UNLABELLED Severe acute respiratory syndrome (SARS) is primarily transmitted by bio-aerosol droplets or direct personal contacts. This paper presents a detailed study of environmental evidence of possible airborne transmission in a Hospital Ward during the largest nosocomial SARS outbreak in Hong Kong in March 2003. Retrospective on-site inspections and measurements of the ventilation design and air distribution system were carried out on July 17, 2003. Limited on-site measurements of bio-aerosol dispersion were also carried out on July 22. Computational fluid dynamics simulations were performed to analyze the bio-aerosol dispersion in the Hospital Ward. We attempted to predict the air distribution during the time of measurement in July 2003 and the time of exposure in March 2003. The predicted bio-aerosol concentration distribution in the Ward seemed to agree fairly well with the spatial infection pattern of SARS cases. Possible improvement to air distribution in the Hospital Ward was also considered. PRACTICAL IMPLICATIONS Our study revealed the need for the development of improved ventilation and air-conditioning systems in an isolation Ward or a general Hospital Ward for infectious respiratory diseases. The outbreak in Ward 8A, which was in a general Hospital and could house nearly 40 patients, demonstrated the cross-infection risks of respiratory infectious diseases in Hospitals if a potential highly infectious patient was not identified and isolated. Our example simulation, which extended the SARS Busters' design for an isolation room to Ward 8A, demonstrated that there was room for improvement to minimize cross-infection in large general Hospital Wards.
Sean M Bagshaw - One of the best experts on this subject based on the ideXlab platform.
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patient family and provider experiences with transfers from intensive care unit to Hospital Ward a multicentre qualitative study
Canadian Medical Association Journal, 2018Co-Authors: Chloe De Grood, Jamie M. Boyd, Jeanna Parsons Leigh, Sean M Bagshaw, Peter Dodek, Robert A Fowler, Alan J Forster, Henry T. StelfoxAbstract:BACKGROUND: Transfer 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. METHODS: We 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. RESULTS: The 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. INTERPRETATION: Patient 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.
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a multi center prospective cohort study of patient transfers from the intensive care unit to the Hospital Ward
Intensive Care Medicine, 2017Co-Authors: Henry T. Stelfox, Jeanna Parsons Leigh, Andrea Soo, Peter Dodek, Alan J Forster, Alexis F Turgeon, Francois Lamontagne, Rob Fowler, Sean M BagshawAbstract:To provide a 360-degree description of ICU-to-Ward transfers. Prospective cohort study of 451 adults transferred from a medical–surgical ICU to a Hospital Ward in 10 Canadian Hospitals July 2014–January 2016. Transfer processes documented in the medical record. Patient (or delegate) and provider (ICU/Ward physician/nurse) perspectives solicited by survey 24–72 h after transfer. Medical records (100%) and survey responses (ICU physicians–80%, ICU nurses–80%, Ward physicians–46%, Ward nurses–64%, patients–74%) were available for most transfers. The median time from initiation to completion of transfer was 25 h (IQR 6–52). ICU physicians and nurses reported communicating with counterparts via telephone (78 and 75%) when transfer was requested (82 and 24%) or accepted (31 and 59%) and providing more elements of clinical information than Ward physicians (mean 4.7 vs. 3.9, p < 0.001) and nurses (5.0 vs. 4.4, p < 0.001) reported receiving. Patients were more likely to report satisfaction with the transfer when they received more information (OR 1.32, 95% CI 1.18–1.48), had their questions addressed (OR 3.96, 95% CI 1.33–11.84), met the Ward physician prior to transfer (OR 4.61, 95% CI 2.90–7.33), and were assessed by a nurse within 1 h of Ward arrival (OR 4.70, 95% CI 2.29–9.66). Recommendations for improvement included having a documented care plan travel with the patient (all stakeholders), standardized face-to-face handover (physicians), avoiding transfers at shift change (nurses) and informing patients about pending transfers in advance (patients). ICU-to-Ward transfers are characterized by failures of patient flow and communication; experienced differently by patients, ICU/Ward physicians and nurses, with distinct suggestions for improvement.
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Prospective cohort study protocol to describe the transfer of patients from intensive care units to Hospital Wards.
BMJ open, 2015Co-Authors: Denise Buchner, Sean M Bagshaw, Peter Dodek, Robert A Fowler, Alan J Forster, Alexis F Turgeon, Francois Lamontagne, Melissa L. Potestio, Henry T. StelfoxAbstract:Introduction The transfer of patient care between the intensive care unit (ICU) and the Hospital Ward is associated with increased risk of medical error and adverse events. This study will describe patient transfer from ICU to Hospital Ward by documenting (1) patient, family and provider experiences related to ICU transfer, (2) communication between stakeholders involved in ICU transfer, (3) adverse events that follow ICU transfer and (4) opportunities to improve ICU to Hospital Ward transfer. Methods This is a mixed methods prospective observational study of ICU to Hospital Ward transfer practices in 10 ICUs across Canada. We will recruit 50 patients at each site (n=500) who are transferred from ICU to Hospital Ward, and distribute surveys to enrolled patients, family members, and healthcare providers (ICU and Ward physicians and nurses) after patient transfer. A random sample of 6 consenting study participants (patients, family members, healthcare providers) from each study site (n=60) will be offered an opportunity to participate in interviews to further describe stakeholders’ experience with ICU to Hospital Ward transfer. We will abstract information from patient health records to identify clinical data and use of transfer tools, and identify adverse events that are related to the transfer. Ethics and Dissemination Research ethics board approval has been obtained at the coordinating study centre (UofC REB13-0021) and 5 study sites (UofA Pro00050646; UBC-PHC H14-01667; Sunnybrook 336-2014; QCH 14-07; Sherbrooke 14-172). Dissemination of the findings will provide a comprehensive description of transfer from ICU to Hospital Ward in Canada including the uptake of validated or local transfer tools, a conceptual framework of the experiences and needs of stakeholders in the ICU transfer process, a summary of adverse events experienced by patients after transfer from ICU to Hospital Ward, and opportunities to guide quality improvement efforts.
Peter V Nielsen - One of the best experts on this subject based on the ideXlab platform.
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Risk of cross-infection in a Hospital Ward with downWard ventilation
Building and Environment, 2010Co-Authors: Peter V Nielsen, Morten Buus, Frederik Vildbrad WintherAbstract:A two-bed Hospital Ward with one standing healthcare person and a ceiling-mounted lowimpulse semicircular inlet diffuser is simulated in a full-scale room. Tracer gas is used for simulating gaseous contaminants, and the concentration is measured at different air change rates and different postures of the patients. A textile partition between the beds, which is typical in a Hospital Ward, is used for protection of the patients in some of the experiments. Three different layouts of return openings are tested. One layout with one opening at the ceiling, another with four openings at the wall opposite to the inlet diffuser, and one with a high location of these four openings. The downWard recirculating flow is on average parallel with the partition, and in most cases the partition does not decrease cross-infection. A high location of the four return openings decreases the risk of cross-infection.
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spatial distribution of infection risk of sars transmission in a Hospital Ward
Building and Environment, 2009Co-Authors: Hua Qian, Peter V Nielsen, Xinhua HuangAbstract:Abstract The classical Wells–Riley model for predicting risk of airborne transmission of diseases assumes a uniform spatial distribution of the infected cases in an enclosed space. A new mathematical model is developed here for predicting the spatial distribution of infection risk of airborne transmitted diseases by integrating the Wells–Riley equation into computational fluid dynamics. We applied our new integrated model to analyze a large nosocomial SARS outbreak in Hong Kong during the 2003 SARS epidemics, which was studied in the literature with regard to the association between airflow and SARS infection. The predicted numbers of infected cases of medical students in the same cubicle, the adjacent cubicle and the distant cubicle were 6.39, 0.78 and 0.2 respectively while the observed numbers of infected medical students in the three cubicles were 7, 0 and 0 respectively during the morning of March 6th, which was the highest attack period. The predicted numbers of infected cases of inpatients during the morning of March 6th in the same cubicle, the adjacent cubic and the distance cubicle were 7.8, 5.1, and 4.8 respectively which also agree well with the observed distribution of the infected inpatients during the entire infection period. The new developed model provides a new modelling tool for investigating the airborne transmission of diseases in enclosed spaces. The model is applicable when the susceptible stays mostly at the same location in an enclosed space during the infectious period, such as inpatients in a Hospital Ward, passengers in an airplane etc.
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dispersion of exhalation pollutants in a two bed Hospital Ward with a downWard ventilation system
Building and Environment, 2008Co-Authors: Hua Qian, Peter V Nielsen, Carl Erik HyldgaardAbstract:Abstract The Centers for Disease Control and Prevention has recommended the use of downWard ventilation systems in isolation rooms to reduce the risk of cross-infection from airborne transmissible diseases. The expected airflow pattern of a downWard ventilation design would supply cooler and slightly heavier clean air from a ceiling diffuser to push down contaminants, which would then be removed via outlets at floor level. A “laminar” (strictly speaking, unidirectional) flow is expected to be produced to avoid flow mixing and thus reduce cross-infection risk. Experiments were carried out in a full-scale experimental Hospital Ward with a downWard ventilation system to investigate the possibility of applying downWard ventilation in a general Hospital Ward. Two life-sized breathing thermal manikins were used to simulate a source patient and a receiving patient. Computation fluid dynamics was also used to investigate the airflow pattern and pollutant dispersion in the test Ward. Based on both experimental and numerical results, the laminar airflow pattern was shown to be impossible to achieve due to turbulent flow mixing and flow entrainment into the supply air stream. The thermal plumes produced above people were found to induce flow mixing. We also studied the effects of the locations of the supply and extraction openings on both the flow pattern and pollutant exposure level in the occupied zone. A number of practical recommendations are suggested.
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dispersion of exhaled droplet nuclei in a two bed Hospital Ward with three different ventilation systems
Indoor Air, 2006Co-Authors: Hua Qian, Peter V Nielsen, Carl Erik Hyldgaard, Tze Wai Wong, A T Y ChwangAbstract:UNLABELLED Effective ventilation in general Hospital Wards is important for controlling the airborne transmission of infectious respiratory diseases. Experiments have been carried out to increase our understanding of the interaction of the breathing flows of two individuals in a full-scale experimental Hospital Ward with three ventilation systems, i.e. mixing, downWard and displacement ventilation. Two life-size breathing thermal manikins were used to simulate a source patient and a receiving patient. The exhalation jet from a bed-lying manikin was visualized using smoke. N2O was used as tracer gas to simulate the droplet nuclei exhaled by patients; and the spatial distribution of its concentrations was measured. Our experimental results show that for both mixing and downWard ventilation, the exhaled jet penetrates a short distance and is diluted quickly by ventilation air. The exhaled droplet nuclei are well mixed in the Ward. Bed distance does not affect the personal exposure of the receiving patient. For displacement ventilation, the exhaled jet can penetrate a long distance. A high concentration layer of exhaled droplet nuclei because of thermal stratification locking has also been observed with displacement ventilation. This work is useful for identifying an appropriate ventilation method that can remove droplet nuclei more effectively and minimize the risk of cross-infections in a Hospital Ward environment. PRACTICAL IMPLICATIONS As one of the major potential sources for infectious droplet nuclei in a Hospital environment, exhalation flows of an infected patient can interact with the respiratory activities of other close individuals and with the room ventilation systems. Our latest results provide information on the penetration of exhalation jets into the ambient environment in different ventilation systems. This work is useful in identifying an appropriate and effective ventilation method for removing droplet nuclei more effectively, and thus minimizing the risk of cross-infections in Hospital Wards with multiple beds.
Alan J Forster - One of the best experts on this subject based on the ideXlab platform.
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patient family and provider experiences with transfers from intensive care unit to Hospital Ward a multicentre qualitative study
Canadian Medical Association Journal, 2018Co-Authors: Chloe De Grood, Jamie M. Boyd, Jeanna Parsons Leigh, Sean M Bagshaw, Peter Dodek, Robert A Fowler, Alan J Forster, Henry T. StelfoxAbstract:BACKGROUND: Transfer 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. METHODS: We 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. RESULTS: The 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. INTERPRETATION: Patient 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.
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a multi center prospective cohort study of patient transfers from the intensive care unit to the Hospital Ward
Intensive Care Medicine, 2017Co-Authors: Henry T. Stelfox, Jeanna Parsons Leigh, Andrea Soo, Peter Dodek, Alan J Forster, Alexis F Turgeon, Francois Lamontagne, Rob Fowler, Sean M BagshawAbstract:To provide a 360-degree description of ICU-to-Ward transfers. Prospective cohort study of 451 adults transferred from a medical–surgical ICU to a Hospital Ward in 10 Canadian Hospitals July 2014–January 2016. Transfer processes documented in the medical record. Patient (or delegate) and provider (ICU/Ward physician/nurse) perspectives solicited by survey 24–72 h after transfer. Medical records (100%) and survey responses (ICU physicians–80%, ICU nurses–80%, Ward physicians–46%, Ward nurses–64%, patients–74%) were available for most transfers. The median time from initiation to completion of transfer was 25 h (IQR 6–52). ICU physicians and nurses reported communicating with counterparts via telephone (78 and 75%) when transfer was requested (82 and 24%) or accepted (31 and 59%) and providing more elements of clinical information than Ward physicians (mean 4.7 vs. 3.9, p < 0.001) and nurses (5.0 vs. 4.4, p < 0.001) reported receiving. Patients were more likely to report satisfaction with the transfer when they received more information (OR 1.32, 95% CI 1.18–1.48), had their questions addressed (OR 3.96, 95% CI 1.33–11.84), met the Ward physician prior to transfer (OR 4.61, 95% CI 2.90–7.33), and were assessed by a nurse within 1 h of Ward arrival (OR 4.70, 95% CI 2.29–9.66). Recommendations for improvement included having a documented care plan travel with the patient (all stakeholders), standardized face-to-face handover (physicians), avoiding transfers at shift change (nurses) and informing patients about pending transfers in advance (patients). ICU-to-Ward transfers are characterized by failures of patient flow and communication; experienced differently by patients, ICU/Ward physicians and nurses, with distinct suggestions for improvement.
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Prospective cohort study protocol to describe the transfer of patients from intensive care units to Hospital Wards.
BMJ open, 2015Co-Authors: Denise Buchner, Sean M Bagshaw, Peter Dodek, Robert A Fowler, Alan J Forster, Alexis F Turgeon, Francois Lamontagne, Melissa L. Potestio, Henry T. StelfoxAbstract:Introduction The transfer of patient care between the intensive care unit (ICU) and the Hospital Ward is associated with increased risk of medical error and adverse events. This study will describe patient transfer from ICU to Hospital Ward by documenting (1) patient, family and provider experiences related to ICU transfer, (2) communication between stakeholders involved in ICU transfer, (3) adverse events that follow ICU transfer and (4) opportunities to improve ICU to Hospital Ward transfer. Methods This is a mixed methods prospective observational study of ICU to Hospital Ward transfer practices in 10 ICUs across Canada. We will recruit 50 patients at each site (n=500) who are transferred from ICU to Hospital Ward, and distribute surveys to enrolled patients, family members, and healthcare providers (ICU and Ward physicians and nurses) after patient transfer. A random sample of 6 consenting study participants (patients, family members, healthcare providers) from each study site (n=60) will be offered an opportunity to participate in interviews to further describe stakeholders’ experience with ICU to Hospital Ward transfer. We will abstract information from patient health records to identify clinical data and use of transfer tools, and identify adverse events that are related to the transfer. Ethics and Dissemination Research ethics board approval has been obtained at the coordinating study centre (UofC REB13-0021) and 5 study sites (UofA Pro00050646; UBC-PHC H14-01667; Sunnybrook 336-2014; QCH 14-07; Sherbrooke 14-172). Dissemination of the findings will provide a comprehensive description of transfer from ICU to Hospital Ward in Canada including the uptake of validated or local transfer tools, a conceptual framework of the experiences and needs of stakeholders in the ICU transfer process, a summary of adverse events experienced by patients after transfer from ICU to Hospital Ward, and opportunities to guide quality improvement efforts.