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Variability in the systems of care supporting critical neonatal intensive care unit transitions.

ABSTRACT: OBJECTIVE:Assess practices supporting care transitions for infants and families in the neonatal intensive care unit (NICU) using a model of four key drivers: communication, teamwork, family integration, and standardization. STUDY DESIGN:Single-day audit among NICUs in the Vermont Oxford Network Critical Transitions collaborative addressing policies and practices supporting the four key drivers during admission, discharge, shift-to-shift handoffs, within hospital transfers, and select changes in clinical status. RESULTS:Among 95 NICUs, the median hospital rate of audited policies in place addressing the four key drivers were 47% (inter-quartile range (IQR) 35-65%) for communication, 67% (IQR 33-83%) for teamwork, 50% (IQR 33-61%) for family integration, and 70% (IQR 56-85%) for standardization. Of the 2462 infants included, 1066 (43%) experienced ?1 specified transition during the week prior to the audit. CONCLUSIONS:We identified opportunities for improving NICU transitions in areas of communication, teamwork, family integration, and standardization.

SUBMITTER: Kaplan HC

PROVIDER: S-EPMC7359434 | biostudies-literature | 2020 Oct

REPOSITORIES: biostudies-literature

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Variability in the systems of care supporting critical neonatal intensive care unit transitions.

Kaplan Heather C HC Edwards Erika M EM Soll Roger F RF Morrow Kate A KA Meyers Jeffrey J Timpson Wendy W Cohen Howard H Fry Marybeth M Schierholz Elizabeth E Buus-Frank Madge E ME Horbar Jeffrey D JD

Journal of perinatology : official journal of the California Perinatal Association 20200714 10

<h4>Objective</h4>Assess practices supporting care transitions for infants and families in the neonatal intensive care unit (NICU) using a model of four key drivers: communication, teamwork, family integration, and standardization.<h4>Study design</h4>Single-day audit among NICUs in the Vermont Oxford Network Critical Transitions collaborative addressing policies and practices supporting the four key drivers during admission, discharge, shift-to-shift handoffs, within hospital transfers, and sel ...[more]

PMID: 32665688

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Project description:Operating room to intensive care unit handoffs are high-risk events for critically ill patients. Studies in selected patient populations show that standardizing operating room to intensive care unit handoffs improves information exchange and decreases errors. To adapt these findings to mixed surgical populations, we propose to study the implementation of a standardized operating room to intensive care unit handoff process in two intensive care units currently without an existing standard process.The Handoffs and Transitions in Critical Care (HATRICC) study is a hybrid effectiveness- implementation trial of operating room to intensive care unit handoffs. We will use mixed methods to conduct a needs assessment of the current handoff process, adapt published handoff processes, and implement a new standardized handoff process in two academic intensive care units. Needs assessment: We will use non-participant observation to observe the current handoff process. Focus groups, interviews, and surveys of clinicians will elicit participants' impressions about the current process. Adaptation and implementation: We will adapt published standardized handoff processes using the needs assessment findings. We will use small group simulation to test the new process' feasibility. After simulation, we will incorporate the new handoff process into the clinical work of all providers in the study units.Using the same methods employed in the needs assessment phase, we will evaluate use of the new handoff process.The primary effectiveness outcome is the number of information omissions per handoff episode as compared to the pre-intervention period. Additional intervention outcomes include patient intensive care unit length of stay and intensive care unit mortality. The primary implementation outcome is acceptability of the new process. Additional implementation outcomes include feasibility, fidelity and sustainability.The HATRICC study will examine the effectiveness and implementation of a standardized operating room to intensive care unit handoff process. Findings from this study have the potential to improve healthcare communication and outcomes for critically ill patients.ClinicalTrials.gov identifier: NCT02267174. Date of registration October 16, 2014.

Dataset Information

Variability in the systems of care supporting critical neonatal intensive care unit transitions.

Publications

Variability in the systems of care supporting critical neonatal intensive care unit transitions.

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