Characterising ICU-ward handoffs at three academic medical centres: process and perceptions

The postimplementation survey cohort of internal medicine trainees and attendings will not be identical to the preimplementation cohort from the prior study.

“A notable limitation is the inconsistency of our postimplementation survey cohort of internal medicine trainees and attendings, which will not be identical to the preimplementation cohort from our prior study [9].”

ICU-ward transitions are managed heterogeneously across health systems.

“ICU–ward transitions are managed heterogeneously across health systems (1), which may affect hospital quality and safety (3).”

ICU-ward patient transfers are vulnerable because of patient complexity, clinical uncertainty, and nonintersecting communication between physicians and nurses.

“Patients transferring from the intensive care unit (ICU) to the hospital wards are vulnerable because of patient complexity, clinical uncertainty, and nonintersecting communication between physicians and nurses (1).”

Despite marked differences in handoff processes across institutions, there was convergence of opinion by residents in focus groups across institutions.

“Despite the marked differences in handoff processes across our institutions (1), there was convergence of opinion by residents in focus groups across institutions, suggesting that this intervention may be generalizable to other academic medical centers.”

PGY-1 residents infrequently hold primary responsibility for ICU-ward transfer communication at our institutions.

“PGY-1 residents will be excluded from the study because they infrequently hold primary responsibility for ICU-ward transfer communication at our institutions [9].”

The survey is identical in content to a preimplementation survey of internal medicine residents conducted at BJH, UC, and UCSF in our prior study, which characterized types of miscommunication errors in ICU-ward handoffs.

“The survey is identical in content to a preimplementation survey of internal medicine residents conducted at BJH, UC, and UCSF in our prior study, which characterized types of miscommunication errors in ICU-ward handoffs [9].”

A recent study of several teaching hospitals demonstrated high rates of communication errors-both commission and omission-and associated harms, including unplanned ICU readmissions, care delays, medication errors, missed results, and patient and family distress.

“A recent study of several teaching hospitals demonstrated high rates of communication errors—both those of commission and omission—and associated harms, including unplanned ICU readmissions, care delays, medication errors, missed results, and patient and family distress [9].”

A preimplementation survey of resident trainees was already conducted at UC, UCSF, and WUSM during the 2015-2018 academic years to evaluate the frequency of communication gaps and medical errors related to ICU-ward transfers.

“A preimplementation survey of resident trainees was already conducted at UC, UCSF, and WUSM during the 2015-2018 academic years to evaluate the frequency of communication gaps and medical errors related to ICU-ward transfers [9].”

The sample size is based on our work with the preimplementation cohort, and we will aim for at least 30% respondents at each site for the postimplementation surveys.

“The sample size is based on our work with the preimplementation cohort, and we will aim for at least 30% respondents at each site for the postimplementation surveys [9].”

More than 87% of ICU doctors indicated that they faced adverse events related to communication issues during handoffs, such as omissions or misunderstandings of crucial diagnostic details, including pending results and required follow-up care.

“More than 87% of ICU doctors indicated that they faced adverse events related to communication issues during handoffs, such as omissions or misunderstandings of crucial diagnostic details, including pending results and required follow-up care [270].”