Lost in relocation: longitudinal surveys evaluating the effectiveness of ICU to ward handover after the introduction of an electronic patient record.

BACKGROUND: Poor communication and lack of standardized handover practices contribute to adverse events. Intensive care organizations recommend standardized, structured written and verbal handover. OBJECTIVES: Investigate the effectiveness of, and barriers to, Intensive Care Unit (ICU) patient handover at ward transfer. Screen for patient safety incidents related to poor handover and improve practice where deficiencies are identified. METHODS: A survey of ward doctors about specific ICU to ward transfers and online surveys ascertaining opinions of handover processes were sent to ward-based and ICU doctors at a large, adult, university affiliated, Australian quaternary hospital. We delivered departmental education and created then publicized a new electronic ICU transfer summary. The summary included a mandatory tick-box to confirm verbal handover completion. Surveys re-assessing practice were then performed. RESULTS: Forty ward-based doctors were surveyed about specific transfers, with 7 (18%) instances of issues related to handover identified. Eighty-seven ward doctors completed the pre-interventions survey; 48 (55%) were aware of the existing written transfer summary. Post-interventions, 47 (75%) of 63 ward doctor responders were aware of it (p < 0.05). Pre-interventions, 14 (16%) ward doctors rated ICU handovers as excellent or good, rising to 21 (34%) post-interventions (p < 0.05). Thirty-nine ICU doctors completed the pre-interventions survey; 5 (13%) rated ICU to ward handover as excellent or good, rising to 9 (35%) when re-surveyed (p = 0.097). CONCLUSIONS: The perceived quality of ICU to ward handover improved after our interventions. However, ICU doctors continue to transfer patients without verbally handing over, with contacting the ward team representing a significant handover barrier.

Trends in the use, complications, and costs of permanent pacemakers in Australia: A nationwide study from 2008 to 2017.

OBJECTIVE: To characterize contemporary pacemaker procedure trends. METHODS: Nationwide analysis of pacemaker procedures and costs between 2008 and 2017 in Australia. The main outcome measures were total, age- and gender-specific implant, replacement, and complication rates, and costs. RESULTS: Pacemaker implants increased from 12,153 to 17,862. Implantation rates rose from 55.3 to 72.6 per 100,000, a 2.8% annual increase (incidence rate ratio [IRR] 1.028; 95% CI, 1.02-1.04; p < .001). Pacemaker implants in the 80+ age group were 17.37-times higher than the < 50 group (95% CI 16.24-18.59; p < .001), and in males were 1.48-times higher than in females (95% CI 1.42-1.55; p < .001). However, there were similar increases according to age (p = .10) and gender (p = .68) over the study period. Left ventricular lead rates were stable (IRR 0.995; 95% CI 0.98-1.01; p = .53). Generator replacements decreased from 20.5 to 18.3 per 100,000 (IRR 0.975; 95% CI 0.97-0.98; p < .001). Although procedures for generator-related complications were stable (IRR 0.995; 95% CI 0.98-1.01; p = .54), those for lead-related complications decreased (IRR 0.985; 95% CI 0.98-0.99; p < .001). Rates for all pacemaker procedures were consistently greater in males (p < .001). Although annual costs of all pacemaker procedures increased from $178 million to $329 million, inflation-adjusted costs were more stable, rising from $294 million to $329 million. CONCLUSIONS: Increasing demand for pacemaker implants is driven by the ageing population and rising rates across all ages, while replacement and complication procedure rates appeared more stable. Males have consistently greater pacemaker procedure rates than females. Our findings have significant clinical and public health implications for healthcare resource planning.