CHARACTERIZING ICU STRUCTURE AND HANDOFF PRACTICES IN MICHIGAN HOSPITALS

Document Type

Conference Proceeding

Publication Date

3-1-2026

Publication Title

Crit Care Med

Keywords

antibiotic agent, medrysone, adult, blue cross blue shield, central vein, conference abstract, controlled study, drug safety, drug therapy, human, intensive care, intensive care psychosis, intensive care unit, major clinical study, Michigan, middle aged, rural hospital, sepsis, urban hospital, urinary catheter

Abstract

INTRODUCTION: Intensive Care Unit (ICU) to floor transfer can be a high-risk time for patients, particularly in hospitals with closed ICUs where the primary team changes when a patient is transferred out of the ICU. We sought to characterize ICU structure and hand-off practices at Michigan hospitals. METHODS: We surveyed hospitals in the Michigan Hospital Medicine Safety Consortium (HMS) Sepsis Initiative, a collaborative quality initiative sponsored by Blue Cross Blue Shield of Michigan. HMS includes 69 hospitals with diverse characteristics. Surveys were completed in spring 2024 by each hospital's HMS representative. The survey included a question about ICU structure: closed (dedicated ICU team) vs open (same team manages patients both in and out of the ICU). A Chi-squared test was used to compare ICU structure by hospital urbanicity (using Rural-Urban Continuum Codes). Hospitals with closed ICUs were asked about use of standardized hand-off tools, including tool type and inclusion of informational elements important for effective transitions of care per the literature. RESULTS: 69/69 (100%) hospitals completed the survey; 37 (53.6%) had closed ICUs, 22 (31.9%) had open ICUs, and 10 (14.5%) reported other ICU structures, most often a combination of open/closed ICUs depending on the unit (e.g., specialty vs medical). Urban hospitals were more likely than rural hospitals to have closed ICUs (94.6% vs 5.4%, p=0.003). Among the 37 hospitals with closed ICUs, 34 (91.9%) had standardized tools to facilitate transfer, most often progress note templates (21, 56.8%), communication guides (20, 54.1%), and transfer note templates (17, 45.9%). Only 9 (24.3%) had hand-off tools that included all 7 key transfer elements: information about urinary catheters (27, 81.8%), temporary central venous access (26, 78.8%), goals of care (24, 72.7%), antibiotic course (23, 69.7%), volume status (20, 60.6%), new controlled medications (18, 54.5%), and ICU delirium (15, 45.5%). CONCLUSIONS: Over half of Michigan hospitals have closed ICUs. While most have standardized hand-off tools to facilitate inter-team communication, these tools are often missing key information. Understanding ICU structure and transfer processes is important to target initiatives to transitions of care for patients with sepsis admitted to the ICU.

Volume

53

Issue

1

First Page

1

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