Study goals

Ascertain determinants of OR-to-ICU handoff protocol adoption and use in 12 adult and pediatric ICUs in five health systems. Determinants (i.e., barriers, enablers) of the adoption and use of handoff protocols operate at multiple socio-ecological levels; there are relevant clinician-, team-, ICU-, and hospital-level determinants to consider in implementation efforts. We will perform on-site mixed-methods contextual inquiries guided by the Tailored Implementation for Chronic Diseases checklist to characterize determinants of handoff protocol adoption, use, and sustainment in each ICU. 

Adapt handoff protocols using engineering approaches and select tailored implementation strategies with implementation mapping (targeting ICU’s Aim 1 determinants). Employing participatory design, we will work with site-based teams to adopt protocols that complement ICU workflow and context while preserving core components of OR-to-ICU handoff protocols, which are (1) a face-to-face team interaction at the patient bedside, and (2) use of a template or checklist to guide information exchange.

Test the effectiveness of tailored, multifaceted, multilevel implementation strategies. Aim 2 products will be implemented using tailored strategies in a stepped-wedge design with randomized roll-out. Implementation outcomes include fidelity (adherence to handoff protocol), sustainment (fidelity over a 2-year period), and implementation cost. Effectiveness outcomes include new-onset organ failure (composite measure), AHRQ PSI 90 (composite measure of adverse events), and clinician workload.

Design and create a digital toolkit for other ICUs to identify implementation determinants, customize an OR-to-ICU handoff protocol, and select appropriate implementation strategies. To facilitate the dissemination, usability, and application of our findings, we will use human-centered design and social marketing to develop visually appealing, usable materials that are transferable to multiple ICU settings.