Handoffs and Transitions in Critical Care (HATRICC) · Handoffs Transfer of patient care and...

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Handoffs and Transitions in Critical Care (HATRICC) Evanie Anglade University of Pennsylvania, 2019 SUMR Scholar, 2017 Meghan Lane-Fall, MD, MSHP Anesthesiology and Critical Care, Perelman School of Medicine

Transcript of Handoffs and Transitions in Critical Care (HATRICC) · Handoffs Transfer of patient care and...

Page 1: Handoffs and Transitions in Critical Care (HATRICC) · Handoffs Transfer of patient care and accountability Found in various care settings because of specialization of care across

Handoffs and Transitions in Critical Care (HATRICC)

Evanie Anglade University

of Pennsylvania, 2019 SUMR Scholar,

2017

Meghan Lane-Fall, MD, MSHP Anesthesiology and Critical Care,

Perelman School of Medicine

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Outline� Background

� Project Overview

� My Role� Phase 3� Phase 4

� My Learning Experience

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Handoffs� Transfer of patient care and accountability

� Found in various care settings because of specialization of care across providers and disciplines1

1. Cohen, Michael D., and P. Brian Hilligoss. "The published literature on handoffs in hospitals: deficiencies identified in an extensive review." Quality and Safety in Health Care (2010): qshc-2009.

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The Big Four

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Significance� Handoffs are high-risk events for acutely ill patients

� delays in diagnosis or treatment� medication errors � physical movement of patients� Transfer of information among providers of different

disciplines� Patient is incapacitated

� 4 – 8 million preventable serious adverse events annually2

� 70% caused by communication problems3

� Of those, 50% handoff-related3

2. James, JT. "A new, evidence-based estimate of patient harms associated with hospital care." Journal of patient saf 2013): 122-128.3. Dunn, Edward J., Peter D. Mills, Julia Neily, Michael D. Crittenden, Amy L. Carmack, and James P. Bagian. "Medical team training: applying crew resource management in the Veterans Health Administration." The Joint Commission Journal on Quality and Patient Safety 33, no. 6 (2007): 317-325.

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Specific Aims1. Perform a needs assessment of the OR-to-ICU

handoff process in two ICUs that serve mixed surgical populations.

2. Adapt and implement a standardized OR-to-ICU handoff process.

3. Evaluate the implementation and effectiveness of a standardized OR-to-ICU handoff process.

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Hypotheses� Intervention effectiveness hypothesis: After

implementing a standard handoff process, the number of information omissions per handoff will decrease by 50%.

� Implementation hypothesis: Clinician acceptance of a new standardized OR-to-ICU handoff process will be high, as assessed qualitatively.

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Study Design

Phase 1 Needs

Assessment

Phase 2 Implementation

Phase 3 EffectivenessEvaluation

Phase 4Sustainability

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HATRICC Conceptual Model

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Standardized Process1. Introduction of providers

2. Stabilization of patient3. Transfer of technology4. Huddle of providers5. Surgery presentation6. Anesthesia presentation

7. ICU presentation8. Physical exam of patient9. Exchange of contact information10.Questions

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Study Results

Quality ofInformation Transfer

Quality of Teamwork

Quality of Professionalism

Number of information omissionsper handoff decreased 22.7%(p=0.028)

Percentage of handoffs rated unsatisfactory teamwork decreased 26.7% (p<0.001)

Percentage of handoffs rated unsatisfactory professionalismdecreased 17.8%(p<0.001)

Before After Before After Before After

4.4±2.7 3.4±1.8 45.3% 18.6% 25% 7.2%

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My Role

Phase 1 Needs

Assessment

Phase 2 Implementation

Phase 3 EffectivenessEvaluation

Phase 4Sustainability

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My Role: Specific Aims1. Help determine accuracy of handoffs before and

after implementation of the standardized process.

2. Consider ways to sustain the standardized handoff process for future care.

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Phase 3: Handoff Accuracy� Question: How did accuracy change after

implementation, if it did?

� Methods: Comparison between handoff observation forms and chart abstraction forms of Phase 1 and those of Phase 3� REDCap

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Accuracy MeasuresAllergies Estimated Blood Loss

Past medical/surgical history Urine output

IV Fluids Current infusions

Blood products

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Accuracy Schematic

Was the info discussed accurate?

Does the patient have allergies?

Was the information discussed complete?

Were allergies discussed during the handoff?

Was the information discussed accurate?

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Ranking System

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Phase 4: Sustainability� HATRICC has improved handoff communication

� Observations in TSICU on HUP Rhoads 5, Presbyterian TSICU4, and NICU on HUP Rhoads 2

� Real-time feedback for clinicians

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Real-Time Feedback� Question: How does real-time feedback for

clinicians affect performance?

� Methods: Literature review� PubMed and Scopus� Included 8 studies between 2005 – 2015

� Results� Sometimes there is a delay in “real-time” feedback

� Passive visual cues for actual real-time � Earlier studies use higher-ups to provide feedback� Later studies use IT to provide feedback

� Computer-mediated feedback

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Remaining Questions� Is real-time feedback conducive to the kind of

environment handoffs take place in?� If so, what would this feedback system look like?

� Who should be providing the feedback?

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My Learning Experience� Making thorough observations

� Maintaining uniformity in observations

� REDCap basics

� Better focusing a literature search

� Thinking critically about already published studies

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AcknowledgementsDr. Meghan Lane-Fall Leonard Davis Institute

Hannah Peifer Wharton Dean’s Office

Lane-Fall Lab 2017 SUMR Cohort

Joanne Levy

Safa Browne

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Questions?