HATRICC: Handoffs and Transitions in Critical Care

Sponsor

University of Pennsylvania (Other)

Overall Status

Completed

CT.gov ID

NCT02267174

Collaborator

Anesthesia Patient Safety Foundation (Other)

1,000

Enrollment

Locations

Arm

Duration (Months)

500

Patients Per Site

20.8

Patients Per Site Per Month

Study Details

Study Description

Brief Summary

The HATRICC study will use mixed methods to implement a standardized process for operating room to intensive care unit handoffs that is accepted and sustainably used by perioperative clinicians.

Condition or Disease	Intervention/Treatment	Phase
Patient Handoff Healthcare Team Communication Patient Safety Intensive Care Units	Behavioral: Standardized handoff	N/A

Detailed Description

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.

Study Design

Study Type:

Interventional

Actual Enrollment :

1000 participants

Allocation:

N/A

Intervention Model:

Single Group Assignment

Masking:

None (Open Label)

Primary Purpose:

Health Services Research

Official Title:

Handoffs and Transitions in Critical Care (HATRICC): Optimizing Operating Room to Intensive Care Unit Handoffs

Study Start Date :

Jul 1, 2014

Actual Primary Completion Date :

Jul 1, 2016

Actual Study Completion Date :

Jul 1, 2016

Arms and Interventions

Arm	Intervention/Treatment
Other: Standardized OR to ICU handoff A standardized handoff process for conducting OR to ICU handoffs will be implemented in two intensive care units without a standard process.	Behavioral: Standardized handoff A standardized handoff will be implemented that consists of choreographed handoffs utilizing a structured handoff tool to facilitate information exchange.

Arm

Intervention/Treatment

Other: Standardized OR to ICU handoff

A standardized handoff process for conducting OR to ICU handoffs will be implemented in two intensive care units without a standard process.

Behavioral: Standardized handoff

A standardized handoff will be implemented that consists of choreographed handoffs utilizing a structured handoff tool to facilitate information exchange.

Outcome Measures

Primary Outcome Measures

Change in information omissions [baseline to 1 month post-intervention]
The number of information omissions per handoff episodes will be determined by direct observation.

Secondary Outcome Measures

Change in teamwork score [baseline to 1 month post-intervention]
Quantitative teamwork score will be determined for each episode of operating room to intensive care unit handoff after the intervention is implemented.
Change in patient length of stay [baseline to 1 month post-intervention]
Patient length of stay in the intensive care unit and in the hospital will be assessed in the post-intervention period.

Other Outcome Measures

Change in qualitative implementation outcomes [baseline to 1 month post-intervention]
Acceptability, appropriateness and fidelity will be assessed qualitatively

Eligibility Criteria

Criteria

Ages Eligible for Study:

18 Years and Older

Sexes Eligible for Study:

All

Accepts Healthy Volunteers:

Yes

Inclusion Criteria:

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

Exclusion Criteria:

None.

Contacts and Locations

Locations

	Site	City	State	Country	Postal Code
1	Hospital of the University of Pennsylvania	Philadelphia	Pennsylvania	United States	19104
2	Penn Presbyterian Medical Center	Philadelphia	Pennsylvania	United States	19104