HUP SICU clinicians discuss patient care.

HUP SICU clinicians discuss patient care.

Overview

This is an ongoing study to improve handoffs from the OR to the ICU at Penn Presbyterian and at HUP. We first conducted a handoff needs assessment (“contextual inquiry”). Based on the assessment we adapted published handoff tools and processes (published by other investigators) to improve peri-procedural communication for patients requiring critical care.

 

Study goals

Just like a "hat trick" in sports, HATRICC has 3 goals:

1. Understand current critical care handoff practices
2. Develop best practices for critical care handoffs
3. Implement handoff improvement interventions

What does the study involve?

The assessment involved handoff observations and implementation of a standard handoff procedure. As part of this work we conducted focus groups, interviews and surveys of front-line clinicians to discuss their handoff experiences and preferences and we conducted in-situ simulation of our new standardized handoff process.

 Schematic of study procedures

Schematic of study procedures

Importance of OR to ICU handoffs

A patient’s transfer from the OR to the ICU is a transition during which information can easily be lost or distorted, leading to errors and preventable harm. There are studies to support handoff standardization through the use of checklist and/or algorithms in the cardiac OR to the cardiac ICU, especially for pediatric patients.  We have been working to figure out how to implement a similar process for mixed surgical populations.

Conceptual model underpinning study design.

Logistics

The study started in July 2014. The study is using an “opt out” approach for observations, and an “opt in” approach for interviews and focus groups.

Pre-specified data collection is complete, the first of several study manuscripts has been published, and we continue to collect data to assess sustainability.