Handoffs and Transitions in Critical Care

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, the investigators 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. The
investigators 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 - The investigators will use
nonparticipant 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 - The investigators will adapt published standardized handoff
processes using the needs assessment findings. The investigators will use small group
simulation to test the new process' feasibility. After simulation, the investigators 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, the
investigators 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.

Inclusion Criteria:

- All clinicians caring for patients being transferred from the operating room to
intensive care unit.

Exclusion Criteria: