The Handoffs and Transition in Critical Care (HATRICC) research project is an implementation research study designed to improve OR-to-ICU handoffs. The project consists of 3 main phases:
Phase 1: Understand the current process and areas of improvements through observations, chart reviews, and interviews.
Phase 2: Development, simulation, and implementation of a new handoff process using data collected from Phase 1.
Phase 3: Evaluation of new process through observations, chart reviews, interviews and surveys (In progress).
After extensive observations and interviews, our research team has designed a standardized handoff protocol to be used both at in the Rhoads 5 SICU at HUP and the new PAC4-TSICU at PPMC. Implementation design means the protocol will vary slightly to reflect the needs of the individual hospital and ICU environments. The overall process can be seen below on the two posters.
Click on the images to zoom in
Explanation of New process
In our new process we hope to refine communication between the four main providers:
1. Surgical team
2. Anesthesia team
3. Primary nurse
4. ICU provider
In this sense, we want to create a post-op time out where (in the best case scenario) all four providers can come together to discuss the transfer of the patient and information.
The purpose of this process is to refine communication between the four main providers: the surgical team, anesthesia team, primary nurse, and ICU provider. In this sense, we want to create a post-op time out where (in the best-case scenario) all four providers can come together to discuss the transfer of the patient and information.
Post-Op Handoff Process Flow Chart
Each ICU room will contain laminated versions of both posters. The first poster is a Post-OP Handoff Process Flow Chart. This chart details the steps of how the handoff should occur:
First, OR staff will call up to the ICU staff prior to patient transport to discuss need-to-know information to allow ICU to prep for patient arrival. At PPMC, the CRNA responsible for patient will make this phone call. At HUP, the OR nurse will be responsible for call.
- Steps 1 and 2: Upon patient arrival, the primary nurse will ask all providers to introduce themselves. (ex: "Who is my surgical provider?"). Patient is stabilized in room and mechanical ventilation is resumed.
- Steps 3 and 4: Secondary nursing staff transfers patient monitors while providers gather, primary nurse asks if everyone is ready for handoff and waits for assent before continuing.
- Steps 5 and 6: OR staff, including surgical team followed by anesthesia team, presents patient information.
- Steps 7 and 8: ICU provider leads a systems-based discussion of immediate postoperative concerns, followed up by nurse. By this time, a short physical examination of patient should occur to make sure all providers are aware of dressings, lines, drains, etc.
- Step 9: Team exchanges contact information.
- Step 10: Any remaining questions about patient are addressed. The handoff is considered complete once all providers are satisfied all questions have been answered.
patient information Chart
In addition to the Post-Op Process Flow Chart, there will be a removable, laminated Patient-Information Chart (see poster above). This chart is designed to be used by providers to record relevant handoff information including, patient history, procedure details, team contact information, and more. This serves to prompt relevant patient details that should be discussed during a handoff, but is not meant to limit the discussion of patient information to what is only covered on the chart.
Note: Because the protocol will be implemented in a general SICU, the patient chart shows only the basic information due to the variety of patient cases. When the protocol becomes a part of other units, such as the HVICU unit at PPMC, the chart will change to reflect the necessary relevant details to that population of patients.
The new HATRICC protocol rolled out in the Rhoads 5 SICU at HUP on June 1 and in the new PAC4-TSICU at PPMC on June 15. Over the next 3 months, our researchers will once again be observing handoffs in the ICU, creating chart abstractions, and conducting interviews to gather feedback on the process and make adjustments to the protocol where necessary. The success of this protocol is entirely dependent on the support from both the ICU and OR staff. It is our goal to make this process as helpful and smooth as possible. Indeed, we hope to improve not only communication and teamwork between providers, but also better patient care and safety.