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Patients win as Ticket to Ward sets bar high

Toronto, November 19, 2015

By James Wysotski

Stew Granger, Alex Roll and Melissa Farne
Registered nurse Stew Granger from the Trauma and Neurosurgery Intensive Care Unit presents the revised Ticket to Ward form while 9 CC ward nurses Alex Roll and Melissa Farne discuss a transfer. (Photo by Yuri Markarov)

Trauma and Neurosurgery has streamlined the Ticket to Ward tool, making it easier to ensure all of a patient’s belongings and valuables are transferred with him or her to the ward and that families know when such moves are taking place.

The tool has been transformed into a legal-style accountability checklist that intensive care nurses present to ward nurses at the time of transfer.

“Before, it was just inconsistent practice,” said Mary Copeland, the clinical leader manager of the Trauma and Neurosurgery ward on 9 Cardinal Carter. “There was no standard way that information was shared. Something like a lack of family knowledge about transfers used to be a common occurrence, but I don't hear such complaints anymore.”

As a Best Practice Spotlight Organization, it was important and in the best interests of patient care and safety for St. Michael’s to improve the quality of these transitions. Before the tool was revised, usage by nurses was 25 per cent. An all-time high of 45 per cent was achieved in August. As a result, communications go much more predictably.

“It's a form the nurses are actually using about things they really want to know about,” said Liz Butorac, the clinical leader manager of the Trauma and Neurosurgery Intensive Care Unit. “Ensuring that transfer orders by physicians are completed is on the form, so they make sure it’s done. I think they're that much more satisfied because the patient’s transition to the ward is much smoother.”

Registered nurses Alex Manzo, from the ward, and Stew Granger, from the intensive care unit, led the project to improve the form. Each spent time on the other’s unit to learn what needed change, such as making sure patients were actually ready for discharge.

The Ticket to Ward form
The Ticket to Ward form. Click here or on image above for a larger version.

“You'd think that working side-by-side with patients going back and forth that it would be obvious, but it's not,” said Copeland. “There were a lot of revisions, such as removing a reference sheet that overloaded the form with too much information. It was a tremendous learning experience with a lot of good stakeholder involvement.”

While all hospital units work on transfer of accountability from shift to shift, Trauma and Neurosurgery's undertaking differs because it's at a point of transition from unit to unit. Accreditation Canada identifies such transition points as key areas of focus for patient safety. The refined communications are expected to improve patient outcomes. Similar initiatives will be rolled out in other areas of the hospital.

“Our next step will be to continue to encourage people to use Ticket to Ward,” said Granger. “I am encouraged by the fact that people are taking it seriously and therefore patients are being transferred with care even in urgent transfer situations."

About St. Michael's Hospital

St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in 27 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael's Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.