JMIR Publications

ABSTRACT

Background:

Transitions in care are vulnerable periods in healthcare that can expose patients to preventable errors due to incomplete or delayed communication between healthcare providers. Transitioning critically ill patients from intensive care units (ICU) to other patient care units (PCU) is particularly risky due to the high acuity of the patients and the diversity of healthcare providers involved in their care. Complete and timely communication between sending and accepting teams is essential for care continuity. Instituting structured documentation to standardize the content of written communication between healthcare providers during transitions has been identified as a promising means to reduce communication breakdowns. As a result, we developed an evidence-informed, computer-enabled, ICU-specific structured tool (eTransfer) to facilitate and standardize the composition of written transfer summaries in the ICUs of one Canadian city.

Objective:

This study is first phase of a two-phase initiative. The overarching goal of the current study is to evaluate whether implementation of our electronic ICU eTransfer tool will streamline communications between healthcare providers during patient transitions from the ICU.

Methods:

This study is a cluster-specific pre-post trial with randomized and staggered implementation of the eTransfer tool in four hospitals in Calgary, Alberta. ICU transfer summaries prepared post-implementation of the eTransfer tool will be compared to summaries prepared pre-implementation using the traditional dictation system. Hospitals (clusters) were allocated randomly at regular intervals to cross over from control (dictation only) to intervention, where providers had access to the eTransfer tool as well as to dictation. A multifaceted knowledge translation strategy consisting of education, point-of-care support, and audit-and-feedback was implemented to facilitate adoption of the eTransfer tool. The primary outcome is a binary composite measure of the timeliness and completeness of transfer summaries which will be compared pre- and post-implementation using chi-squared tests for each hospital. Secondary measures include overall completeness, timeliness, and provider ratings of transfer summaries; hospital and ICU lengths of stay; and post-ICU patient outcomes including ICU readmission, adverse events, cardiac arrest, rapid response team activation, and mortality.

Results:

Participating hospitals were cluster randomized to the intervention between July 2018 and January 2019. Extraction of ICU patient admission lists was completed September 2019. Outcome data is currently being collected from a retrospective random sample of patients admitted to study ICUs six months pre- and six months post-implementation of the tool at each hospital. We anticipate data collection to be completed by summer 2020, with first results ready for publication in fall 2020.

Conclusions:

This study will report the impact of implementing an evidence-informed, computer-enabled, ICU-specific structured transfer tool on communication and preventable medical errors among patients transferred from the ICU to other hospital care units. Clinical Trial: ClinicalTrials.gov Identifier NCT03590002; https://www.clinicaltrials.gov/ct2/show/NCT03590002 (first posted 18 July, 2018).