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

Abstract

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.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2482-14-96) contains supplementary material, which is available to authorized users.

Failure to Debrief after Critical Events in Anesthesia Is Associated with Failures in Communication during the Event

“…21,22 The fact that events centering on a communication breakdown are less likely to be debriefed highlights the value of preventing communication problems in the first place through medical education and patient-safety-based interventions such as checklists, handoffs, and simulation-based training. 7,8,[23][24][25] Crisis checklists, emergency manuals, and other cognitive aids have long been embraced as tools to improve crisis resource management and patient safety. 3,26,27 There are simulation-based training programs in existence to improve debriefing skills, encourage higher-quality conversations, and excavate reasoning, which are directly relevant to the anesthesia provider.…”

Lapse in Antibiotics Leads to Sepsis

“…A recent investigation demonstrated a decreased number of omissions per hand over between the OR and ICU with the use of a simple checklist . In another survey, physicians identified early communication, team member participation, and collaborative relationships as key factors facilitating a reduction of errors associated with transition between the OR and the ICU . The common theme in most published studies is the benefits of using tools to focus communication and attention to details during these interunit transitions.…”

Handoffs in the Intensive Care Unit

“…As described elsewhere, 27 trained research staff directly observed OR-to-ICU bedside handoffs at all times of day. Research staff consisted of 4 students who were trained in observational assessment and who practiced observing OR-to-ICU handoffs with physicians prior to the beginning of the study.…”