Perceived facilitators and barriers to high-quality transfers from ICU to hospital ward, identified by patients and families*
| Theme and subtheme | Facilitators | Barriers | Quote |
|---|---|---|---|
| Resource availability | |||
| Staff availability | ✓ | ✓ | “Just knowing that they [ICU providers] were there if there was a problem … they stressed that, I have to say, that there was always somebody going to be available and they were right there.” Patient (Interview 4) |
| Material resources (e.g., beds, medical record) | ✓ | “They said ‘we’re not particularly sure that you are exactly … ready to leave ICU. We’re very sorry, we’ve got a major trauma coming in and you’re doing a whole lot better, we have to move you.’ They just had no beds left.” Family member (Interview 7_2) | |
| Interprofessional collaboration (e.g., social work, physicians, nurses) | ✓ | “The social worker from the trauma unit came down a few days beforehand and told me what unit I would be transferred to and even then she gave a little bit of a rundown on what I should expect.” Patient (Interview 20) | |
| Provider follow-up | ✓ | “I remember a nurse that I had seen previously. I’d been in there for a lengthier stay and she either heard or saw me coming down. She came down to say hello. Just hello, hi, you know, seeing me again. That was really nice, you know. It gives you more of a comfort level. You know, you’re not just a package.” Patient (Interview 5_1) | |
| Patient–provider communication | |||
| Family kept informed | ✓ | “It would’ve been nice if someone could’ve called and explained it [description of transfer process] to me. I couldn’t always be there... I respect that they’re really busy and they’re not necessarily thinking of discussing things with family members.” Family member (Interview 8) | |
| Communication aids (e.g., informational brochure, white board in patient room) | ✓ | ✓ | “It just feels like when you get to unit you’re all by yourself and there hasn’t been any communication from ICU. They don’t know your situation. You have to explain … that’s one of the big things in the hospital, explaining the situation. Sometimes 3, 4, 5, 10 times a day, it feels like.” Family member (Interview 7_2) |
| Ward orientation before transfer | ✓ | “The transfer process was largely, you know, he is physically going to be moved to another ward, the nature of the care will be different, he will be in a four-bed room as opposed to a two-, you know, person room, there will be fewer machines he will be hooked up to. I knew all of that was going to happen, so that wasn’t a surprise. It didn’t feel like a lessening quality of care, it actually felt hopeful because he didn’t have to be in ICU anymore.” Family member (Interview 2_2) | |
| Consistency of information delivered (e.g., variation in what providers say) | ✓ | ✓ | “[The health care staff] will say ‘rumour has it that you will be leaving our care going to a ward’ … You can’t ask people questions when it’s impossible for them know the answer.” Patient (Interview 7_1) |
| Institutional culture | |||
| Role clarity (e.g., stating name and purpose during provider–patient interaction) | ✓ | “So I would have preferred doctors introduce themselves and spell out their name or have a card that you could refer to because it just felt awkward to not know exactly who the doctor was even though you were seeing that person once a day or so.” Family member (Interview 2_2) | |
| Patient education | ✓ | “There were courses to prepare you for physiotherapy and how to get better … . It was very good.” Patient (Interview 9) | |
| Humanization of patient–provider interactions | ✓ | “It was the contact with the people. How the people were with me. That made me feel comfortable. That was the most important thing. And I think that’s why I think I could handle it [the transfer] and why I accepted it, because it was scary, you know? But I was treated like a normal person. Talked to like a normal person.” Patient (Interview 4) | |
| Investment in family well-being | ✓ | “In our second stay [my wife] stayed at one of the hospital facilities; it’s called the outpatient residence. So when I had an emergency, they phoned her and she was probably closer to the ICU than I was at that point. Patient (Interview 7_1) | |
Note: ICU = intensive care unit.
↵* Identified facilitators and barriers were reported as per-participant experience and do not necessarily represent an absolute list.