hare a common patient population and include over 20 medical disciplines. The patients that are admitted to the PICU tend to progress to intermediate care and then general pediatric care.
Coordination of patient placement with timely transfer of child patients between the units has been a problem. When transfers are poorly coordinated there is a lack of continuity of care for the patient. Each of the services had different protocols and different round times, and each transferred patients without considering the other unit. Resident physicians must coordinate transfers with attending physicians and when the surgeon is in the operating room, a patient may wait all day to be transferred. Evening rounds resulted in orders for transfer being written and carried out during the night, which upset parents and the patient. New patients who were admitted on the day they were to receive surgery had to wait for available beds. Nurses tried to negotiate transfers but they remained uncoordinated and resulted in high stress for everyone as well as a lack of optimal bed utilization (Haack & Shaw,á1996).
Haack and Shawá(1996) proposed solutions to the problems involved in patient transfer. A multidisciplinary group was formed to determine methods for optimal patient placement. Team members included the nursing director for maternal/child health, nurse managers from the different units, staff nurses, the chief resident of pediatrics, the director of hospital admissions, and the physician director of the PICU/IMC. Representatives from respiratory therapy and pharmacy were included when needed. Since nurses were the ones to oversee patients as they were transferred, they were the logical group needed to make patient transfer decisions. Goals of the task force were to charge patients according to levels of care by intensity of care rather than location of care and to minimize patient transfers to improve consistency and coordinatio...