Interprofessional Training and Communication Practices Among Clinicians in the Postoperative ICU Handoff.

BACKGROUND: Operating room (OR)-to-ICU handoffs require coordinated communication between clinicians with different professional backgrounds. However, individual studies have not simultaneously evaluated handoff training and OR-to-ICU handoff practices among interprofessional clinicians that participate in these team-based handoffs. METHODS: The objective of this study was to characterize communication training, practices, and preferences of interprofessional clinicians who engage in OR-to-ICU handoffs. The researchers conducted a mixed methods cohort study using surveys (quantitative) and semistructured interviews (qualitative). Surveys aimed to quantitatively assess the quality of prior handoff training, preferences for clinical information in handoffs, and participation in various handoff activities. Interviews aimed to elicit more in-depth clinician perspectives on these topics through open-ended discussion. The frontline clinicians who were surveyed and interviewed included surgery and anesthesia residents, registered nurses, and advanced practice providers who worked in two ICUs at an urban academic medical center in the United States. RESULTS: In a survey with a 71.8% response rate (130/181), 45.7% (32/70) of residents, 17.4% (4/23) of certified registered nurse anesthetists (CRNAs), 83.3% (10/12) of ICU nurse practitioners (NPs), and 81.0% (17/21) of ICU RNs indicated that their clinical degree-granting education had not provided adequate preparation for OR-to-ICU handoffs. On-the-job training was deemed not adequate preparation by 35.7% (25/70) of residents, 21.7% (5/23) of CRNAs, 58.3% (7/12) of ICU NPs, and 23.8% (5/21) of ICU RNs. Through 30 semistructured interviews, clinicians from all professions expressed interest in interprofessional communication education and in understanding the perspectives and priorities of care team members in OR-to-ICU handoffs. Clinicians also highlighted the potential value of interprofessional communication training taking place early in a clinical career, during degree-granting education. CONCLUSION: Clinicians exhibit profession-based differences in OR-to-ICU handoff training, practices, and information needs. Education focused on interprofessional communication is a potential approach to facilitate improved OR-to-ICU handoff communication.

Observational Study of Clinician Attentional Reserves (OSCAR): Acuity-Based Rounds Help Preserve Clinicians' Attention.

OBJECTIVES: Team rounding in the ICU can tax clinicians' finite attentional resources. We hypothesized that a novel approach to rounding, where patients are seen in a decreasing order of acuity, would decrease attentional attrition. DESIGN: Prospective interventional internal-control cohort study in which stop signal task testing was used as a proxy for attentional reserves. Stop signal task is a measure of cognitive control and response inhibition in addition to performance monitoring, all reflective of executive control abilities, and our surrogate for attentional reserves. SETTING: The ICUs of Vanderbilt University Medical Center (site 1) and the University of Pennsylvania (site 2) from November 2014 to August 2017. SUBJECTS: Thirty-three clinicians at site 1, and 24 clinicians at site 2. INTERVENTIONS: Acuity-based rounding, in which clinicians round from highest to lowest acuity as determined by Sequential Organ Failure Assessment score or an equivalent acuity score. MEASUREMENTS AND MAIN RESULTS: The stop signal task results of ICU staff at two sites were compared for conventional (in room order) versus novel (in decreasing order of acuity) rounding order. At site 1, the difference in stop signal reaction time change between two rounding types was -39.0 ms (95% CI, -50.6 to -27.4 ms; p < 0.001), and at site 2, the performance stop signal reaction time was -15.6 ms (95% CI, -29.1 to -2.1 ms; p = 0.023). These sub-second changes, while small, are significant in the neuroscience domain. CONCLUSIONS: Rounding in decreasing order of patient acuity mitigated attrition in attentional reserves when compared with the traditional rounding method.

Developing a Standard Handoff Process for Operating Room-to-ICU Transitions: Multidisciplinary Clinician Perspectives from the Handoffs and Transitions in Critical Care (HATRICC) Study.

BACKGROUND: Operating room (OR)-to-ICU handoffs place patients at risk for preventable harm. Numerous studies have described standardized handoff procedures following cardiac surgery, but no existing literature describes a general OR-to-ICU handoff system. METHODS: As part of the Handoffs and Transitions in Critical Care (HATRICC) study, a postoperative handoff procedure was developed by conducting interviews and focus groups with staff routinely involved in OR-to-ICU patient transitions in two mixed surgical ICUs, which included nurses, house staff, and advanced practice providers. Transcripts were analyzed according to grounded theory. Surveys, attending physician interviews, and field notes further informed process development. RESULTS: Interviews were conducted with 62 individuals, and three focus groups were held with 19 participants. Clinicians endorsed the importance of the OR-to-ICU handoff but identified several barriers to consistently achieving an ideal handoff-mainly, time pressure, unclear expectations, and confusion about other clinicians' informational needs. Participants were receptive to a standardized handoff process, provided that it was not overly prescriptive. Surveys (n = 132) revealed unreliable information transfer with current OR-to-ICU handoffs. These findings and preexisting OR-to-ICU handoff literature were used to develop a novel handoff process and information template suitable for standard use in a mixed surgical ICU. CONCLUSION: OR and ICU teams agreed on handoffs' importance but expressed important barriers to consistently practicing ideal handoffs. Future work is needed to determine whether the handoff procedures developed by incorporating bedside provider perspectives improve patient outcomes.