Using a Design Thinking Framework to Create User-Centered ICU-Ward Handoffs from Intensive Care Resident Teams to Academic Hospitalist Teams

ABSTRACT

RATIONALE The discharge of patients from the ICU to the hospital ward is a high-risk period. Previously, we used Human-Centered Design - an iterative, collaborative process for user-focused solutions - to develop a prototype structured ICU-ward transfer communication tool for clinicians by focusing on resident-to-resident communication. We describe here an approach to rapid prototyping with the specific focus on meeting the needs academic Hospitalists. METHODS: In winter 2021, we conducted a voluntary focus group of Hospitalists at the University of Chicago to ensure that a recently developed ICU- ward transfer tool created through prior focus groups with resident also met the needs of hospital medicine clinicians. The focus group was conducted via videoconference due to the COVID-19 pandemic. With participants' consent, we recorded and transcribed the focus group discussions conducted over the Zoom platform. Following transcription, qualitative analysis on the transcript was used to look for common themes and concerns. Coding was performed using both a theory driven (deductive) and data driven (inductive) approach. RESULTS: The focus group identified several main themes around the role, content, and workflows related to an ideal ICU-wards handoff tool (1) how the tool can communicate the patient course clearly through multiple verbal hand-offs;(2) that the ICU-ward handoff process must balance thoroughness, usability, and reducing the propagation of copy/paste errors;and (3) that design and implementation should provide hand-off communication between providers and patient families. Under these themes, participants identified specific attributes of an ideal handoff tool (Table 1), which coalesced around 3 main goals (1) to synthesize key details and communicate the ICU team's thought process and follow up tasks (summarized in Table 1A);(2) to integrate the new tool into the EHR that minimizes documentation errors and communicates transfer status in the EHR to help handoffs between shifts (1B);and (3) to serve as a standardized process to ensure communication is bridged between teams and patient families (1C). CONCLUSIONS: Participants valued organization of handoff information, succinct information, EHR integration, and standardization of family communication when modifying a framework. One notable difference is our Hospitalist group focused on brevity while our resident group preferred a longer detailed course. Further work will need to be performed to find balance the needs between these two groups to ensure efficient handoffs.