Standardizing communication during ICU transfers of oncology patients.

Abstract

e23299 Background: Oncology patients have complex care plans. During transitions of care, precise communication of diagnostic, prognostic, and treatment information between medical teams is crucial. We recognized the lack of a standardized communication tool for floor-to-ICU (FTI) transfers of oncology patients. We aimed to increase the percentage of FTI transfers for oncology patients with sufficient written communication by developing a generalizable transfer template with an oncology-specific component to be implemented at the Hospital of the University of Pennsylvania. Methods: Key stakeholders were engaged across all Department of Medicine inpatient services. We conducted voice of the customer (VoC) interviews with the liquid oncology, solid oncology, and intensive care clinical teams. Incorporating this feedback, we developed a system-wide note template in the electronic medical record (EMR) called ICU-PASS. The template encourages users to summarize acute clinical events, interventions taken, outstanding results, and family communications. The tool was launched in 5/2025. Direct outreach to clinical teams and an educational campaign were conducted in the first 3 months post-launch, continuing until 8/2025. Usage data was collected through EMR tools. Retrospective review was conducted to evaluate changes to post-intervention documentation quality. Quantitative outcomes were analyzed with descriptive and inferential statistics. Results: The VoC interviews revealed disparate practices in FTI transfer documentation and a desire for more consistent, detailed descriptions of goals of care (GOC) conversations. An oncology-specific component was developed with three key elements: 1) name and notification of the outpatient oncologist; 2) a list of active chemotherapy with treatment intent; and 3) therapy-related GOC. One month before implementation, 46% (11/24) of oncology FTI transfers had complete documentation of critical events. The ICU-PASS had an oncology FTI usage during the initial 3 months of active intervention of 86.1% (62/72) (p < 0.01). In the subsequent 3 months of passive utilization, the ICU-PASS had a usage rate of 72.7% (99/136) (p = 0.01). The time needed to complete FTI transfer notes decreased from an average of 83 minutes (min) to 26 min. Complete documentation of GOC communication increased from 4.1% to 71.4% (p < 0.01). The percentage of these FTI transfers with an advanced care planning (ACP) note documented within 48 hours of transfer improved from 16.6% to 57.1% (p = 0.01). Conclusions: This study demonstrated an effective interdisciplinary approach to implementing an EMR-based standardized FTI communication tool, as well as the sustained impact of the tool on patient safety beyond a period of active intervention. Our tool significantly increased the transfer documentation rate, while also improving note efficiency and the ability of receiving teams to have timely GOC discussions.