Handoffs and transitions in critical care-understanding scalability: study protocol for a multicenter stepped wedge...

Area of Science:

• Critical care medicine
• Implementation science
• Health systems engineering

Background:

• Evidence-based practices in critical care are hindered by time pressure and patient acuity, creating evidence-to-practice gaps.
• Effective interventions for intensive care unit (ICU) patients are less impactful due to implementation challenges.
• Understanding implementation determinants is crucial for improving critical care settings.

Purpose of the Study:

• To test the effectiveness of a customized protocol for structuring communication during operating room (OR) to ICU handoffs.
• To identify and address implementation determinants in diverse critical care settings.
• To evaluate the impact of standardized OR-to-ICU handoffs on patient outcomes and communication.

Main Methods:

• A Type 2 hybrid effectiveness-implementation trial using a stepped wedge design across 12 ICUs in 5 academic health systems.
• Mixed methods incorporating contextual inquiry, implementation mapping, and human-centered design.
• Primary outcomes include fidelity to the handoff protocol and new-onset organ failure.

Main Results:

• The study will customize, implement, and evaluate standardized OR-to-ICU handoff procedures.
• Findings will assess protocol effectiveness and implementation determinants in varied US academic medical centers.
• Results will quantify the impact on communication and clinical outcomes.

Conclusions:

• Standardized OR-to-ICU handoffs have the potential to improve postsurgical communication.
• This intervention may decrease adverse clinical outcomes in critical care settings.
• The study will inform the broader implementation of evidence-based practices in critical care.