Handoffs and transitions in critical care-understanding scalability: study protocol for a multicenter stepped wedge type 2 hybrid effectiveness-implementation trial

Meghan B Lane-Fall, Athena Christakos, Gina C Russell, Bat-Zion Hose, Elizabeth D Dauer, Philip E Greilich, Bommy Hong Mershon, Christopher P Potestio, Erin W Pukenas, John R Kimberly, Alisa J Stephens-Shields, Rebecca L Trotta, Rinad S Beidas, Ellen J Bass, Meghan B Lane-Fall, Athena Christakos, Gina C Russell, Bat-Zion Hose, Elizabeth D Dauer, Philip E Greilich, Bommy Hong Mershon, Christopher P Potestio, Erin W Pukenas, John R Kimberly, Alisa J Stephens-Shields, Rebecca L Trotta, Rinad S Beidas, Ellen J Bass

Abstract

Background: The implementation of evidence-based practices in critical care faces specific challenges, including intense time pressure and patient acuity. These challenges result in evidence-to-practice gaps that diminish the impact of proven-effective interventions for patients requiring intensive care unit support. Research is needed to understand and address implementation determinants in critical care settings.

Methods: The Handoffs and Transitions in Critical Care-Understanding Scalability (HATRICC-US) study is a Type 2 hybrid effectiveness-implementation trial of standardized operating room (OR) to intensive care unit (ICU) handoffs. This mixed methods study will use a stepped wedge design with randomized roll out to test the effectiveness of a customized protocol for structuring communication between clinicians in the OR and the ICU. The study will be conducted in twelve ICUs (10 adult, 2 pediatric) based in five United States academic health systems. Contextual inquiry incorporating implementation science, systems engineering, and human factors engineering approaches will guide both protocol customization and identification of protocol implementation determinants. Implementation mapping will be used to select appropriate implementation strategies for each setting. Human-centered design will be used to create a digital toolkit for dissemination of study findings. The primary implementation outcome will be fidelity to the customized handoff protocol (unit of analysis: handoff). The primary effectiveness outcome will be a composite measure of new-onset organ failure cases (unit of analysis: ICU).

Discussion: The HATRICC-US study will customize, implement, and evaluate standardized procedures for OR to ICU handoffs in a heterogenous group of United States academic medical center intensive care units. Findings from this study have the potential to improve postsurgical communication, decrease adverse clinical outcomes, and inform the implementation of other evidence-based practices in critical care settings.

Trial registration: ClinicalTrials.gov identifier: NCT04571749 . Date of registration: October 1, 2020.

Keywords: Critical care; Ergonomics; Evidence-based practice; Human factors engineering; Hybrid effectiveness-implementation trials; Implementation science; Medical communication; Patient handoff; Patient safety; Postoperative period; Transition of care.

Conflict of interest statement

RSB receives royalties from Oxford University Press. She has served as a consultant to Camden Coalition of Healthcare Providers. She provides consultation to United Behavioral Health. She serves on the Clinical and Scientific Advisory Board for Optum Behavioral Health. The remaining authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
a Clinician participants and roles in the OR-to-ICU handoff. b OR-to-ICU handoff protocol
Fig. 2
Fig. 2
Study team structure and governance
Fig. 3
Fig. 3
Hybrid of Proctor’s implementation model and the social ecological model
Fig. 4
Fig. 4
Exemplar process map of OR-to-ICU handoffs

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