Evidence Supporting Clinician Acceptance of a Standardized Handoff - - PowerPoint PPT Presentation

Evidence Supporting Clinician Acceptance of a Standardized Handoff Process

Meghan Lane-Fall, MD, MSHP Anesthesiology and Critical Care University of Pennsylvania Perelman School of Medicine

Financial disclosures

• No conflicts of interest
• Funding sources:
• Anesthesia Patient Safety

Foundation

• Robert Wood Johnson Foundation
• NIH-NHLBI PRIDE Research in

Implementation Science for Equity

Handoffs in hospitals are problematic

• Handoffs are transfers of

patient care responsibility

• When handoffs go poorly,

patients experience preventable harm

• Two major types of handoffs:
• Shift-to-shift handoffs
• Transitions in care

OR to ICU handoffs are a type of transition in care

surgeon ICU provider anesthetist ICU nurse

Standards improve OR to ICU handoffs

• At least 15 studies show

improvement with standardization:

• Increased information exchange
• Better team functioning
• Improved short-term patient outcomes
• Evidence largely limited to

homogenous surgical populations

Two research questions

Research questions

1. Does handoff standardization work in a heterogeneous surgical population?

• 2. What influences implementation of

a standardized handoff process?

Study design:

• Type 1 hybrid effectiveness-

implementation trial (Curran 2012)

• Mixed methods (QUAL + QUAN)

HATRICC: Handoffs and Transitions in Critical Care

HATRICC conceptual model

Two years of work

July – December 2014

Characterize current state of OR to ICU handoffs

Observations, surveys, interviews, focus groups January – May 2015

Design and test standardized handoff process

In-situ simulation and debriefing June 2015

Implementation of HATRICC process

Intensive support and education, surveys July 2015 – January 2016

Evaluate performance with HATRICC process

Observations, surveys, interviews, focus groups February 2016 – present

Ongoing support, scale up, education

Spread to other UPHS units, KnowledgeLink tutorial, study based at Christiana Care Health System

Our OR to ICU handoff process incorporated clinician input

Our implementation

• utcomes

do not have validated measures

Outcome Measure type Data sources

Acceptability, appropriateness Qualitative Interviews, focus groups, field notes Quantitative Surveys Feasibility Qualitative Interviews, focus groups, field notes Fidelity Qualitative Interviews, focus groups, field notes Quantitative Observations

Focus on acceptability

“Acceptability is the perception among implementation stakeholders that a given treatment, service, practice, or innovation is agreeable, palatable, or satisfactory.” (Proctor 2011)

Why acceptability?

• Discretion in clinician

behavior mandates acceptable interventions

• Early in conceptual model
• Conceptually straightforward

Who determines acceptability?

Acceptability determined by stakeholder groups:

Surgeons Clinical leaders ICU providers Nurses Anesthetists

We assessed acceptability in multiple ways

Quantitative acceptability measures from surveys:

• 136/152 (89.5%) said that the

new process was acceptable

• 125/160 (78.1%) always or

usually used the new process

• 107/156 (68.7%) said the new

process made patient care better or much better

We assessed acceptability in multiple ways Qualitative acceptability assessment from interviews, focus groups, field notes, event reporting system:

“Patient arrived to Rhoads 5 SICU from PACU with no HATRICC handoff/signout from primary team.”

Conclusion

Clinicians demonstrate acceptability of a new handoff process in multiple ways

Next steps

• Analyze qualitative data for

factors influencing acceptability

• Evaluate acceptability over time
• Assess factors influencing

acceptability across settings as intervention spreads

Acknowledgements

HATRICC collaborators:

• Rinad Beidas, PhD
• Frances Barg, PhD, MEd
• Lee Fleisher, MD
• Jose Pascual, MD, PhD
• Juliane Jablonski, DNP

, CCRN

• Jacob Gutsche, MD
• Scott Halpern, MD, PhD

Lane-Fall lab group Penn patients and clinicians Anesthesia Patient Safety Foundation