HATRICC: HANDOFFS AND TRANSITIONS IN CRITICAL CARE, A STUDY FOR THE IMPROVEMENT OF

PATIENT CRITICAL CARE

Mentor: Dr. Meghan Lane-Fall, MD, MSHP

By: Enrique Torres Hernandez, St. Mary’s University ‘17 &

Jerome Watts Jr., Haverford College ‘17

WHAT IS A HANDOFF?

The Patient

The Patient

The OR Provider

The ICU Provider

A BETTER PICTURE

WHAT IS A HANDOFF? v Transition of responsibility for patient care from one

provider to another in the healthcare system • Types of handoffs:

o ICU to OR o OR to PACU o Radiology to ICU o Physician to another Physician o ER to ICU, etc.

v HATRICC focuses on OR to ICU handoffs

WHY ARE HANDOFFS IMPORTANT? v Handoffs in critical care play a huge role in the continuation of care, quality of care, reduction of risks and errors, and the protection of patients to avoidable harm that they might be susceptible to while in the ICU.

v Sentinel Events

v Previous literature is limited and it’s been only recently that research has began in this field

WHY OR TO ICU HANDOFFS? v Potential problems • Transfer of patient • Transfer of technology • Communication

v Consequences • Injury • Medication errors • Function

PREVIOUS LITERATURE v Has shown that about 80% of sentinel events can be attributed to

miscommunication and errors when a patient is changing providers

v Some measured handoff quality based on aspects of handoff such as the transfer of technology

v Not enough information about clinical outcomes to make definitive conclusions.

v Recommended more research, broader population, and other delivery formats.

v Sample sizes too small to produce statistical significance.

PREVIOUS LITERATURE

v Standardization of the handoffs increase information transfer

v Time for handoff tends to trend downwards following standardization

v State a gap in the literature relating handoff quality to clinical outcomes

v Needed more varied surgical population.

RELATIONSHIP BETWEEN HANDOFFS AND PATIENT OUTCOMES

WHAT IS HATRICC?

Sorry…

WHAT IS HATRICC?

v HATRICC stands for “Handoffs and Transitions in Critical Care • Three goals:

o 1. Understand current critical care handoff practices o 2. Develop best practices for critical care handoffs o 3. Implement handoff improvement interventions

IMPLEMENTATION

v Involved clinicians and introduced them to the process

v Our role: • Resource for anyone with questions about HATRICC • Received feedback from staff/clinicians regarding the new

process • Gave out gift cards and candy!

NO CUTTING CORNERS

v Interviews/focus groups

v Perspectives on each phase

v Online Qualtrics Surveys

v RedCap

v Open-ended questions

v ICU Handoff Tool

THE OPERATING ROOM (OR)

v Location of surgical operations

v Many hands involved • Composed of: o Surgery team o Anesthesia team § Both have different goals § Don’t always communicate

THE INTENSIVE CARE UNIT (ICU)

C O N S I S T O F :

v Physicians (i.e. Attending, Fellows, and Residents)

v N.Ps – Nurse Practitioners v P.As – Physicians Aides v R.Ns – Registered Nurses

T Y P E S O F I C U :

v TSICU v SICU v HVICU (etc…) v Specific to patient’s

needs

WHERE WE WORKED

H O S P I T A L O F U N I V E R S I T Y O F P E N N S Y L V A N I A

P E N N S Y L V A N I A P R E S B Y T E R I A N M E D I C A L C E N T E R

v TSICU/HVICU v Smaller/Newer v Level 1 Trauma v Neuro patients v Culture change

v Rhoads 5 SICU v Different services v Green/Gold teams

OUR JOB AS OBSERVERS

v  We worked in the TSICU in PPMC and in the SICU at HUP Rhoads5.

v Tasks: • Phase 3 of the Project • We observed the handoffs from the OR to the ICU o Focused on both content and the actions of the “Big Four”:

§ Anesthesia representative, Surgery Representative, ICU Physician, ICU RN

• Collected qualitative and quantitative data

WHAT WE USED

TIME FOR YOU TO GET TO WORK v Task:

• Take note of: o Focus on the info o Who is who o Body language

VIDEO SIMULATION

REPORT

v Follow-up Questions: • What did you see? • Anything stand out to you?

SOME IMPORTANT ANNOTATIONS

v When comparing observed handoffs in the ICU that use the HATRICC standardized process to handoffs in ICU’s that do not have any standardized process: •  It is evident that the handoffs with the HATRICC standardized

process seem to omit less critical patient information • Those handoffs with the standardized process also appear to result

in overall better teamwork between different clinical teams • Clinicians seem to be satisfied with the new process, as it makes

the handoff more efficient and easier for them when compared to the unstandardized handoffs

v  There may be a possible correlation between teamwork and communication rating and number of questions

THE FUTURE OF THE STUDY v  Observations will continue to be recorded until the ideal sample size is reached

before reaching thematic saturation.

v  We will also be providing immediate feedback to the participating clinicians about their strengths and weakness during handoffs

v  After the observations and chart reviews are finished, we will conduct more focus groups and interviews with various clinicians to assess their opinion on the new HATRICC process

v  We will also compare the results of the effectiveness of HATRICC in improving clinical outcomes for patients (HATRICC is the only study to look clinical outcomes for patients thus far!)

v  For more information or to follow the study, you can visit: http://www.hatricc.com/

REFLECTIONS

THANK YOU

•  Dr. Lane-Fall •  Joanne Levy

•  Safa Browne •  Laura Di Taranti (Project Manager)

•  The rest of the HATRICC Team

•  LDI •  HUP (Hospital of the University of Pennsylvania)

•  Penn Presbyterian Hospital •  Penn Medicine

•  Anesthesia and Critical Care

QUESTIONS???