JMIR Publications

ABSTRACT

Background:

The intensive care unit (ICU)-ward transfer poses a particularly high-risk period for patients, and has been associated with miscommunication and adverse outcomes during clinician handoff. Standardized handoff processes are understudied at the ICU-ward interface, which remains vulnerable to suboptimal practices. We previously developed a user-centered, electronic ICU-ward transfer tool, ICU-PAUSE, which embeds the key elements and diagnostic reasoning to facilitate a safe transfer of care at ICU discharge.

Objective:

To evaluate the feasibility, acceptability, and adoption of a novel EHR-embedded transfer tool, ICU-PAUSE, in the ICU-ward transfer process across ten academic medical centers.

Methods:

ICU-PAUSE will be implemented in the medical ICU across ten academic hospitals, with each site customizing the tool to their institution’s needs. Our mixed-methods study will include a combination of chart review, quantitative surveys, and qualitative interviews. Firstly, we will conduct a retrospective chart review of ICU-ward transfer notes to assess uptake of ICU-PAUSE. Secondly, we will perform post-implementation surveys and semi-structured interviews of faculty stakeholders. Our thematic analysis will be informed by sociotechnical theory to elicit perceptions of feasibility and acceptability of implementation. Lastly, we will collect survey responses from house officers and hospitalist physicians to evaluate the impact of ICU-PAUSE on communication errors and adverse outcomes during ICU-ward transfers.

Results:

ICU-PAUSE was piloted in the medical ICU at Barnes-Jewish Hospital, the teaching hospital of Washington University School of Medicine in St. Louis, in 2019. As of July 2022, implementation of ICU-PAUSE is ongoing at six of ten participating sites. Our results will be published in early 2023.

Conclusions:

Our process of ICU-PAUSE implementation embeds each step of template design, uptake, and customization in the needs of users and key stakeholders. Here, we introduce our approach to evaluate its acceptability, usability, and impact on communication errors according to the tenets of sociotechnical theory. We anticipate that ICU-PAUSE will offer an effective handoff tool for the ICU-ward transition that can be generalized to other institutions.