Goal: To increase patient safety via promoting patient continuity as patients return to a Housestaff floor service (defined as the Housestaff General Medicine, Cardiology, or Oncology floor teams) after being in the ICU (defined as either the MICU or CCU) for 72 hours or less.
Who this applies to: Patients who were initially on a Housestaff floor service, were transferred to the ICU, and are now transferring back to the same Housestaff floor service after 72 hours or less in the ICU.
- When a patient is being transferred out of the ICU, the ICU team should contact 9100 as per the usual protocol. If the patient previously came from a Housestaff floor service, 9100 will page the on-call team for that Housestaff floor service to find out which team the patient came from and if the senior resident from the original team is still present that day.
- If the original senior resident is already gone for the day or is off that day, the patient should enter the general triaging pool and be triaged to the appropriate on-call team. The patient should not be held on the floor or remain in the ICU for the original provider to return the following day (no overnight holdovers).
- If the original senior resident is still present for the day, they should strongly consider taking the patient back to their team as a bounceback.
- While the decision to accept a bounceback is left up to the senior resident and attending from the original team, the expectation is that the resident will take the patient back when it is most likely beneficial for patient care. The below guidelines are exceptions to when the patient returning to the prior team would not be beneficial for patient care. If the senior resident decides to not take the patient back, the patient then should be triaged via 9100 to the appropriate on-call team. If there are concerns or questions about when to accept a patient as a bounceback, the resident or 9100 should reach out to the Chief Resident On Call (CROC).
Considerations for when NOT to take a patient back as an ICU Bounceback:
- They have been in the ICU for over 72 hours.
- The original team senior resident has rotated off of the service.
- The original team senior resident is off on the day of transfer back to the floor or is already gone for the day. The patient should NOT be held on the floor or remain in the ICU for the original provider to return the following day (NO overnight holdovers).
- Taking the patient back would cause either the intern or the senior resident to exceed their total team caps (10 per intern, 20 per resident). If a team takes a patient back on a call day, the patient will count towards their admitting cap for the day.
- If the original Housestaff floor team took care of the patient for <24 hours prior to transfer to the ICU.
- If the patient is a high risk of bounceback to the ICU overnight and could benefit from closer monitoring from a 24-hour call resident.
- If there was a poor therapeutic relationship with the patient and/or patient’s family and the original team thinks the patient would benefit from a new provider.
There is no perfect set of rules for bouncebacks. If there is any confusion on this situation, please page the CROC.