From the Society

Transition in care from the MICU to the ward


Editor’s Note: The Society of Hospital Medicine’s (SHM’s) Physician in Training Committee launched a scholarship program in 2015 for medical students to help transform healthcare and revolutionize patient care. The program has been expanded for the 2017-18 year, offering two options for students to receive funding and engage in scholarly work during their first, second and third years of medical school. As a part of the program, recipients are required to write about their experience on a biweekly basis.

This summer, my research project focused on the highly vulnerable patients who are transferred from the medical intensive care unit to the general floor. Patients who are readmitted tend to have worse health outcomes, longer stays, higher mortality rates, and higher health care costs. Previous research shows that higher quality handoffs, where receiving and transferring providers share the same shared mental model, result in better outcomes. We were interested in learning whether these shared mental models are being formed as a result of handoffs between the ward and the MICU.

Anton Garazha, a medical student at Chicago Medical School at Rosalind Franklin University in North Chicago.

Anton Garazha

After surveying providers this summer, and using data from past surveys, we have been able to make headway codifying the level of concordance between providers. We asked ward and MICU providers what they thought was the most important component of care in regards to the care of their patient while they are on the general floor. We focused on two levels of agreement in the handoff: intra-team agreement within the MICU team, and inter-team agreement between the MICU team and the ward. We coded intra-team agreement within the categories of “Complete,” “Strong,” “Weak,” and “No” agreement based on a random sampling of 40 unique patient encounters determined in meetings with Dr. Vineet Arora, Dr. Juan Rojas, Dr. Julie Neborak, and me. Due to a variable number of responses from providers on either side, we also coded the inter-team responses as “Full,” “Partial,” and “No” in order to determine the amount of concordance between teams.

The current results reveal that 18% of MICU teams shared a complete mental model, 25% shared a strong shared mental model, 9% shared a weak mental model, 30% shared no mental model, and 18% of patient encounters did not have a sufficient number of MICU respondents. Regarding inter-team communication, 7% shared a full shared mental model, 49% shared a partial mental model, 30% shared no shared mental model, and 14% of unique patient encounters did not have enough respondents.

With complex patient cases, it can be difficult to identify the most important factor of care for a particular patient. However, I think this information would be very useful in identifying whether these exchanges result in individuals prioritizing the same factor of care for their respective patient. I think this information would be very useful in future quality improvement, and seeing whether this communication results in the formation of shared mental models.

Anton Garazha is a medical student at Chicago Medical School at Rosalind Franklin University in North Chicago. He received his bachelor of science degree in biology from Loyola University in Chicago in 2015 and his master of biomedical science degree from Rosalind Franklin University in 2016. Anton is very interested in community outreach and quality improvement, and in his spare time tutors students in science-based subjects.

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