Handoffs and transitions in critical care (HATRICC): protocol for a mixed methods study of operating room to intensive care unit handoffs

BMC Surgery

Frances K Barg⁴  Lee A Fleisher³  Scott D Halpern⁷  Jacob T Gutsche⁸  Mark E Barry⁶  Tyler J Chavez¹  Hannah G Peifer⁵  Meredith L Collard⁸  Jose L Pascual²  Rinad S Beidas⁹  Meghan B Lane-Fall³ 

[1] College of Arts and Sciences, New Mexico State University, Las Cruces, NM 88003, USA;School of Nursing, University of Pennsylvania, Philadelphia, PA 19104, USA;Leonard Davis Institute of Health Economics, University of Pennsylvania, Colonial, Penn Center, 3641 Locust Walk, Philadelphia, PA 19104, USA;Department of Medical Anthropology, School of Arts and Sciences, University of Pennsylvania, Philadelphia, PA 19104, USA;School of Arts and Sciences, University of Pennsylvania, Philadelphia, PA, USA;Center for Healthcare Improvement and Patient Safety, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, 1209 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104, USA;Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, 719 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104, USA;Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, 680 Dulles Building, Philadelphia, PA 19104, USA;Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Philadelphia, PA 19104, USA

关键词: Simulation;    Postoperative care;    Intensive care unit;    Handoffs;    Patient safety;    Quality improvement;    Implementation;   

Others  :  1091137
DOI  :  10.1186/1471-2482-14-96

 received in 2014-08-29, accepted in 2014-10-22,  发布年份 2014

【 摘 要 】

Background

Operating room to intensive care unit handoffs are high-risk events for critically ill patients. Studies in selected patient populations show that standardizing operating room to intensive care unit handoffs improves information exchange and decreases errors. To adapt these findings to mixed surgical populations, we propose to study the implementation of a standardized operating room to intensive care unit handoff process in two intensive care units currently without an existing standard process.

Methods/Design

The Handoffs and Transitions in Critical Care (HATRICC) study is a hybrid effectiveness- implementation trial of operating room to intensive care unit handoffs. We will use mixed methods to conduct a needs assessment of the current handoff process, adapt published handoff processes, and implement a new standardized handoff process in two academic intensive care units. Needs assessment: We will use non-participant observation to observe the current handoff process. Focus groups, interviews, and surveys of clinicians will elicit participants’ impressions about the current process. Adaptation and implementation: We will adapt published standardized handoff processes using the needs assessment findings. We will use small group simulation to test the new process’ feasibility. After simulation, we will incorporate the new handoff process into the clinical work of all providers in the study units. Evaluation: Using the same methods employed in the needs assessment phase, we will evaluate use of the new handoff process. Data analysis: The primary effectiveness outcome is the number of information omissions per handoff episode as compared to the pre-intervention period. Additional intervention outcomes include patient intensive care unit length of stay and intensive care unit mortality. The primary implementation outcome is acceptability of the new process. Additional implementation outcomes include feasibility, fidelity and sustainability.

Discussion

The HATRICC study will examine the effectiveness and implementation of a standardized operating room to intensive care unit handoff process. Findings from this study have the potential to improve healthcare communication and outcomes for critically ill patients.

Trial registration

ClinicalTrials.gov identifier: NCT02267174. Date of registration October 16, 2014.

【 授权许可】

   
2014 Lane-Fall et al.; licensee BioMed Central Ltd.

【 图 表 】

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【 参考文献 】

• [1]Arora V, Kao J, Lovinger D, Seiden SC, Meltzer D: Medication discrepancies in resident sign-outs and their potential to harm. J Gen Intern Med 2007, 22:1751-1755.
• [2]Horwitz LI, Moin T, Krumholz HM, Wang L, Bradley EH: Consequences of inadequate sign-out for patient care. Arch Intern Med 2008, 168:1755-1760.
• [3]Cohen MD, Hilligoss PB: The published literature on handoffs in hospitals: deficiencies identified in an extensive review. Qual Saf Health Care 2010, 19:493-497.
• [4]Kaufman J, Twite M, Barrett C, Peyton C, Koehler J, Rannie M, Kahn MG, Schofield S, Ing RJ, Jaggers J, Hyman D, da Cruz EM: A handoff protocol from the cardiovascular operating room to cardiac ICU is associated with improvements in care beyond the immediate postoperative period. Jt Comm J Qual Patient Saf 2013, 39:306-311.
• [5]Petrovic MA, Aboumatar H, Baumgartner WA, Ulatowski JA, Moyer J, Chang TY, Camp MS, Kowalski J, Senger CM, Martinez EA: Pilot implementation of a perioperative protocol to guide operating room-to-intensive care unit patient handoffs. J Cardiothorac Vasc Anesth 2012, 26:11-16.
• [6]Salzwedel C, Bartz HJ, Kuhnelt I, Appel D, Haupt O, Maisch S, Schmidt GN: The effect of a checklist on the quality of post-anaesthesia patient handover: a randomized controlled trial. Int J Qual Health Care 2013, 25:176-181.
• [7]Joy BF, Elliott E, Hardy C, Sullivan C, Backer CL, Kane JM: Standardized multidisciplinary protocol improves handover of cardiac surgery patients to the intensive care unit. Pediatr Crit Care Med 2011, 12:304-308.
• [8]Craig R, Moxey L, Young D, Spenceley NS, Davidson MG: Strengthening handover communication in pediatric cardiac intensive care. Paediatr Anaesth 2012, 22:393-399.
• [9]Agarwal HS, Saville BR, Slayton JM, Donahue BS, Daves S, Christian KG, Bichell DP, Harris ZL: Standardized postoperative handover process improves outcomes in the intensive care unit: a model for operational sustainability and improved team performance. Crit Care Med 2012, 40:2109-2115.
• [10]Catchpole KR, De Leval MR, McEwan A, Pigott N, Elliott MJ, McQuillan A, Macdonald C, Goldman AJ: Patient handover from surgery to intensive care: using formula 1 pit- stop and aviation models to improve safety and quality. Paediatr Anaesth 2007, 17:470-478.
• [11]Zavalkoff SR, Razack SI, Lavoie J, Dancea AB: Handover after pediatric heart surgery: a simple tool improves information exchange. Pediatr Crit Care Med 2011, 12:309-313.
• [12]Karakaya A, Moerman AT, Peperstraete H, Francois K, Wouters PF, de Hert SG: Implementation of a structured information transfer checklist improves postoperative data transfer after congenital cardiac surgery. Eur J Anaesthesiol 2013, 30:764-769.
• [13]Segall N, Bonifacio AS, Schroeder RA, Barbeito A, Rogers D, Thornlow DK, Emery J, Kellum S, Wright MC, Mark JB: Can we make postoperative patient handovers safer? A systematic review of the literature. Anesth Analg 2012, 115:102-115.
• [14]Lane-Fall MB, Brooks AK, Wilkins SA, Davis JJ, Riesenberg LA: Addressing the mandate for hand-off education: a focused review and recommendations for anesthesia resident curriculum development and evaluation. Anesthesiology 2014, 120(1):218-29.
• [15]Bonifacio AS, Segall N, Barbeito A, Taekman J, Schroeder R, Mark JB: Handovers from the OR to the ICU. Int Anesthesiol Clin 2013, 51:43-61.
• [16]Curran GM, Bauer M, Mittman B, Pyne JM, Stetler C: Effectiveness-implementation hybrid designs: combining elements of clinical effectiveness and implementation research to enhance public health impact. Med Care 2012, 50:217-226.
• [17]Tan JA, Helsten D: Intraoperative handoffs. Int Anesthesiol Clin 2013, 51:31-42.
• [18]Jayaswal S, Berry L, Leopold R, Hart SR, Scuderi-Porter H, Digiovanni N, Phillips A: Evaluating safety of handoffs between anesthesia care providers. Ochsner J 2011, 11:99-101.
• [19]Anwari JS: Quality of handover to the postanaesthesia care unit nurse. Anaesthesia 2002, 57:488-493.
• [20]Evans AS, Yee MS, Hogue CW: Often overlooked problems with handoffs: from the intensive care unit to the operating room. Anesth Analg 2014, 118:687-689.
• [21]Damschroder L, Aron D, Keith R, Kirsh S, Alexander J, Lowery J: Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci 2009, 4:50. BioMed Central Full Text
• [22]Hays DG, Singh AA: Qualitative inquiry in clinical and educational settings. New York, NY: Guilford Press; 2012.
• [23]Horwitz LI, Dombroski J, Murphy TE, Farnan JM, Johnson JK, Arora VM: Validation of a handoff assessment tool: The Handoff CEX. J Clin Nurs 2012, 22:1477-1486.
• [24]Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG: Research electronic data capture (REDCap)-A metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009, 42:377-381.
• [25]Proctor E, Silmere H, Raghavan R, Hovmand P, Aarons G, Bunger A, Griffey R, Hensley M: Outcomes for implementation research: conceptual distinctions, measurement challenges, and research agenda. Adm Policy Ment Health 2011, 38:65-76.
• [26]Chen JG, Wright MC, Smith PB, Jaggers J, Mistry KP: Adaptation of a postoperative handoff communication process for children with heart disease: a quantitative study. Am J Med Qual 2011, 26:380-386.
• [27]Powell BJ, McMillen JC, Proctor EK, Carpenter CR, Griffey RT, Bunger AC, Glass JE, York JL: A compilation of strategies for implementing clinical innovations in health and mental health. Med Care Res Rev 2012, 69:123-157.
• [28]Schoenwald SK, Garland AF, Chapman JE, Frazier SL, Sheidow AJ, Southam-Gerow MA: Toward the effective and efficient measurement of implementation fidelity. Adm Policy Ment Health 2011, 38:32-43.
• [29]Guest G, MacQueen KM, Namey E: Applied Thematic Analysis. Thousand Oaks, CA: Sage Publications; 2011.
• [30]Guest G, Bunce A, Johnson L: How many interviews are enough? An experiment with data saturation and variability. Field Methods 2006, 18:59-82.
• [31]Chaudoir SR, Dugan AG, Barr CH: Measuring factors affecting implementation of health innovations: a systematic review of structural, organizational, provider, patient, and innovation level measures. Implement Sci 2013, 8:22. BioMed Central Full Text