重症监护中的交接与过渡（HATRICC）：一项关于手术室到重症监护病房交接的混合方法研究方案
Handoffs and transitions in critical care (HATRICC): protocol for a mixed methods study of operating room to intensive care unit handoffs.
作者信息
Lane-Fall Meghan B, Beidas Rinad S, Pascual Jose L, Collard Meredith L, Peifer Hannah G, Chavez Tyler J, Barry Mark E, Gutsche Jacob T, Halpern Scott D, Fleisher Lee A, Barg Frances K
机构信息
Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, 680 Dulles Building, Philadelphia, PA 19104, USA.
出版信息
BMC Surg. 2014 Nov 19;14:96. doi: 10.1186/1471-2482-14-96.
BACKGROUND
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.
METHODS/DESIGN: 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.
EVALUATION
Using the same methods employed in the needs assessment phase, we will evaluate use of the new handoff process.
DATA ANALYSIS
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.
DISCUSSION
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.
TRIAL REGISTRATION
ClinicalTrials.gov identifier: NCT02267174. Date of registration October 16, 2014.
背景
手术室到重症监护病房的交接对于重症患者来说是高风险事件。针对特定患者群体的研究表明，规范手术室到重症监护病房的交接可改善信息交流并减少差错。为使这些研究结果适用于混合手术人群，我们提议在目前尚无标准流程的两个重症监护病房研究实施标准化的手术室到重症监护病房交接流程。
方法/设计：重症监护中的交接与过渡（HATRICC）研究是一项关于手术室到重症监护病房交接的混合有效性-实施性试验。我们将采用混合方法对当前交接流程进行需求评估，改编已发表的交接流程，并在两个学术性重症监护病房实施新的标准化交接流程。需求评估：我们将采用非参与性观察来观察当前的交接流程。焦点小组、临床医生访谈及调查将获取参与者对当前流程的看法。改编与实施：我们将根据需求评估结果改编已发表的标准化交接流程。我们将采用小组模拟测试新流程的可行性。模拟之后，我们将把新的交接流程纳入研究单位所有医护人员的临床工作中。
评估
我们将使用需求评估阶段采用的相同方法评估新交接流程的使用情况。
数据分析
主要有效性结果是与干预前期相比，每次交接事件中遗漏信息的数量。其他干预结果包括患者在重症监护病房的住院时长和重症监护病房死亡率。主要实施结果是新流程的可接受性。其他实施结果包括可行性、保真度和可持续性。
讨论
HATRICC研究将检验标准化的手术室到重症监护病房交接流程的有效性和实施情况。本研究的结果有可能改善重症患者的医疗沟通及治疗效果。
试验注册
ClinicalTrials.gov标识符：NCT02267174。注册日期：2014年10月16日。
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