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Developing a standard handoff process for operating room-to-ICU transitions: Multidisciplinary clinician perspectives from the handoffs and transitions in critical care (HATRICC) study

Joint Commission Journal on Quality and Patient Safety August 27, 2018

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PAIR Center Research Team


BACKGROUND: Operating room (OR)-to-ICU handoffs place patients at risk for preventable harm. Numerous studies have described standardized handoff procedures following cardiac surgery, but no existing literature describes a general OR-to-ICU handoff system.

METHODS: As part of the Handoffs and Transitions in Critical Care (HATRICC) study, a postoperative handoff procedure was developed by conducting interviews and focus groups with staff routinely involved in OR-to-ICU patient transitions in two mixed surgical ICUs, which included nurses, house staff, and advanced practice providers. Transcripts were analyzed according to grounded theory. Surveys, attending physician interviews, and field notes further informed process development.

RESULTS: Interviews were conducted with 62 individuals, and three focus groups were held with 19 participants. Clinicians endorsed the importance of the OR-to-ICU handoff but identified several barriers to consistently achieving an ideal handoff-mainly, time pressure, unclear expectations, and confusion about other clinicians’ informational needs. Participants were receptive to a standardized handoff process, provided that it was not overly prescriptive. Surveys (n = 132) revealed unreliable information transfer with current OR-to-ICU handoffs. These findings and preexisting OR-to-ICU handoff literature were used to develop a novel handoff process and information template suitable for standard use in a mixed surgical ICU.

CONCLUSION: OR and ICU teams agreed on handoffs’ importance but expressed important barriers to consistently practicing ideal handoffs. Future work is needed to determine whether the handoff procedures developed by incorporating bedside provider perspectives improve patient outcomes.


The Anesthesia Patient Safety Foundation