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

BMC Surgery

Study Protocol

Mark E Barry¹  Tyler J Chavez²  Meredith L Collard³  Jacob T Gutsche³  Meghan B Lane-Fall⁴  Lee A Fleisher⁵  Frances K Barg⁶  Jose L Pascual⁷  Scott D Halpern⁸  Rinad S Beidas⁹  Hannah G Peifer^1,10 

[1] Center for Healthcare Improvement and Patient Safety, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, 1209 Blockley Hall, 423 Guardian Drive, 19104, Philadelphia, PA, USA;College of Arts and Sciences, New Mexico State University, 88003, Las Cruces, NM, USA;Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street680 Dulles Building, 19104, Philadelphia, PA, USA;Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street680 Dulles Building, 19104, 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, 19104, Philadelphia, PA, USA;Leonard Davis Institute of Health Economics, University of Pennsylvania, Colonial, Penn Center, 3641 Locust Walk, 19104, Philadelphia, PA, USA;Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street680 Dulles Building, 19104, Philadelphia, PA, USA;Leonard Davis Institute of Health Economics, University of Pennsylvania, Colonial, Penn Center, 3641 Locust Walk, 19104, Philadelphia, PA, USA;Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, 19104, Philadelphia, PA, USA;Department of Family Medicine, Perelman School of Medicine, University of Pennsylvania, 3620 Hamilton Walk, 19104, Philadelphia, PA, USA;Department of Medical Anthropology, School of Arts and Sciences, University of Pennsylvania, 19104, Philadelphia, PA, USA;Department of Surgery, Division of Traumatology, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, 5 Maloney Building, 19104, Philadelphia, PA, USA;School of Nursing, University of Pennsylvania, 19104, Philadelphia, PA, USA;Leonard Davis Institute of Health Economics, University of Pennsylvania, Colonial, Penn Center, 3641 Locust Walk, 19104, Philadelphia, PA, 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, 19104, Philadelphia, PA, USA;Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, 19104, Philadelphia, PA, USA;Leonard Davis Institute of Health Economics, University of Pennsylvania, Colonial, Penn Center, 3641 Locust Walk, 19104, Philadelphia, PA, USA;Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, 19104, Philadelphia, PA, USA;School of Arts and Sciences, University of Pennsylvania, Philadelphia, PA, USA;

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

DOI  :  10.1186/1471-2482-14-96

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

来源: Springer

【 摘 要 】

BackgroundOperating 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/DesignThe 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.DiscussionThe 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 registrationClinicalTrials.gov identifier: NCT02267174. Date of registration October 16, 2014.

【 授权许可】

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