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

Meghan B Lane-Fall, Rinad S Beidas, Jose L Pascual, Meredith L Collard, Hannah G Peifer, Tyler J Chavez, Mark E Barry, Jacob T Gutsche, Scott D Halpern, Lee A Fleisher, Frances K Barg, Meghan B Lane-Fall, Rinad S Beidas, Jose L Pascual, Meredith L Collard, Hannah G Peifer, Tyler J Chavez, Mark E Barry, Jacob T Gutsche, Scott D Halpern, Lee A Fleisher, Frances K Barg

Abstract

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.

Figures

Figure 1
Figure 1
HATRICC conceptual model.
Figure 2
Figure 2
Shared features of OR-to-ICU handoffs in published studies.
Figure 3
Figure 3
Handoff observation stratification scheme.

References

    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. doi: 10.1007/s11606-007-0415-x.
    1. 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. doi: 10.1001/archinte.168.16.1755.
    1. 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.
    1. 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.
    1. 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. doi: 10.1053/j.jvca.2011.07.009.
    1. 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. doi: 10.1093/intqhc/mzt009.
    1. 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. doi: 10.1097/PCC.0b013e3181fe25a1.
    1. Craig R, Moxey L, Young D, Spenceley NS, Davidson MG. Strengthening handover communication in pediatric cardiac intensive care. Paediatr Anaesth. 2012;22:393–399. doi: 10.1111/j.1460-9592.2011.03758.x.
    1. 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. doi: 10.1097/CCM.0b013e3182514bab.
    1. 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. doi: 10.1111/j.1460-9592.2006.02239.x.
    1. 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. doi: 10.1097/PCC.0b013e3181fe27b6.
    1. 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. doi: 10.1097/EJA.0b013e328361d3bb.
    1. 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. doi: 10.1213/ANE.0b013e318253af4b.
    1. 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. doi: 10.1097/ALN.0000000000000070.
    1. 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. doi: 10.1097/AIA.0b013e31826f2b0e.
    1. 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. doi: 10.1097/MLR.0b013e3182408812.
    1. Tan JA, Helsten D. Intraoperative handoffs. Int Anesthesiol Clin. 2013;51:31–42. doi: 10.1097/AIA.0b013e31826f30ea.
    1. 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.
    1. Anwari JS. Quality of handover to the postanaesthesia care unit nurse. Anaesthesia. 2002;57:488–493. doi: 10.1046/j.0003-2409.2001.02406.x.
    1. 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. doi: 10.1213/ANE.0000000000000075.
    1. 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. doi: 10.1186/1748-5908-4-50.
    1. Hays DG, Singh AA. Qualitative inquiry in clinical and educational settings. New York, NY: Guilford Press; 2012.
    1. 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. doi: 10.1111/j.1365-2702.2012.04131.x.
    1. 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. doi: 10.1016/j.jbi.2008.08.010.
    1. 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. doi: 10.1007/s10488-010-0319-7.
    1. 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. doi: 10.1177/1062860610394342.
    1. 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. doi: 10.1177/1077558711430690.
    1. 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. doi: 10.1007/s10488-010-0321-0.
    1. Guest G, MacQueen KM, Namey E. Applied Thematic Analysis. Thousand Oaks, CA: Sage Publications; 2011.
    1. Guest G, Bunce A, Johnson L. How many interviews are enough? An experiment with data saturation and variability. Field Methods. 2006;18:59–82. doi: 10.1177/1525822X05279903.
    1. 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. doi: 10.1186/1748-5908-8-22.
Pre-publication history
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