Clinical trial NCT03590002: Evaluating the Effectiveness of an Electronic Medical Transfer Tool to Improve Communication During Transfers From ICU
Official title: A Cluster-specific Pre-post Trial With Randomized and Staggered Implementation to Evaluate the Effectiveness of an Electronic ICU Medical Transfer of Care Document to Improve Communication During ICU-to-Ward Transfers of Care
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Critical Illness
Transitions of Care
Keywords: Patient Transfer
Patient Discharge Summaries
Continuity of Patient Care
Intensive Care Unit
Critical Care
Health Information Exchange
Medical Order Entry Systems
Point-of-Care Systems
Medical Informatics
Lead sponsor: University of Calgary
Sponsor class: OTHER
Collaborators: name: Canadian Frailty Network
name: Alberta Health services
name: Canadian Institutes of Health Research (CIHR)
First posted: 2018-07-18
Enrollment: 1751
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: CROSSOVER
Intervention model description: All study ICUs will begin as control sites (i.e., no electronic medical transfer tool available). ICUs will be randomly allocated to cross over to the intervention (i.e., electronic medical transfer tool available) at regular intervals (approximately every eight weeks) until all ICUs receive the intervention.
Primary purpose: HEALTH_SERVICES_RESEARCH

Brief summary: The transfer of patients from the intensive care unit (ICU) to a medical or surgical hospital ward is a particularly high risk transfer that may expose patients to complications or adverse events if there are communication breakdowns between sending and receiving medical teams. Current dictation practice often falls short in producing optimal clinical documentation on patients being transferred from the ICU to the ward. The use of an electronic transfer of care tool to standardize communication may improve the quality of information exchanged between ICU and ward medical teams during ICU transfers, compared to dictation. This study will stagger implementation of a new electronic ICU medical transfer of care tool across four adult medical-surgical ICUs in one city. It is anticipated that the electronic ICU transfer tool will positively impact two inter-related goals: (1) improve the completeness and timeliness of clinical documentation on transfer, and (2) reduce the incidence of associated adverse patient clinical outcomes after transfer (e.g., adverse events, ICU readmission).

Detailed description: Background: Transfers of care within hospital are vulnerable periods in health care delivery. The complete, accurate, and timely communication of essential patient information is particularly critical in transfers of care from the intensive care unit (ICU) to an inpatient ward. The ICU generally has the most vulnerable patients, the highest resource use, and most complex system of multi professional coordinated care within the hospital. Communication breakdowns between ICU and receiving inpatient medical teams can have profound implications on the quality, delivery and cost of patient care. Ineffective transfers may result in adverse events, redundant testing, increased hospital stays, and readmission to ICU or hospital.

The written transfer summary is a widely used and important means to present and prioritize patient information to healthcare providers. Unlike verbal reporting, written communication is durable and accessible to many providers at many points in time, making it a critical component in facilitating continuity of patient care. Despite known shortcomings, dictation remains standard practice in many hospitals to complete ICU medical transfer summaries. Although the optimal content and structure for transfer summaries have not been agreed upon in the scientific community, it is clear that standardization can help minimize both the incidence and impact of information gaps during transfer. Computer-enabled tools that remind and guide the user to document essential content (e.g., goals of care, medications) have been found to improve the relevance, consistency, and readability of information in transfer summaries.

Methods: This study will use a cluster-specific pre-post trial design with randomized and staggered implementation to assess the effectiveness of an electronic transfer of care tool developed in the primary clinical information system (Sunrise Clinical Manager, Eclipsys Corporation, Boca Raton, FL) by a multidisciplinary team of healthcare providers and clinical documentation specialists. Four adult medical surgical ICUs in one Canadian city will begin as control sites (i.e., no electronic medical transfer tool available) and subsequently be allocated in a random order to cross over to intervention sites (i.e., electronic medical transfer tool available) at regular intervals. Implementation intervals will be matched to medical resident rotation block dates, which occur every four weeks; a single study interval will encompass two resident blocks. Users--physicians and nurse practitioners responsible for completing ICU medical transfer summaries--will have access to the electronic medical transfer tool at intervention sites, in addition to standard dictation services. A multi-component knowledge translation (KT) strategy designed to facilitate adoption of the tool will be tailored and delivered to ICUs prior to implementation at the site. The KT strategy will encompass education, point-of-care support, and audit and feedback.

Data will be collected both prospectively and retrospectively to measure perceived (prospective user survey) and actual (retrospective chart review) quality of the transfer summaries. The primary outcome will be a binary composite measure of two transfer summary conditions, manually collected retrospectively: (1) presence of four essential information elements (goals of care designation, diagnosis, active issues on transfer, medications to continue) and (2) availability of the transfer summary to accepting clinicians at the time of patient transfer. Transfer summaries that meet these two conditions will be coded as "Present"; those that do not will be coded as "Absent". Patient clinical outcome data also will be retrospectively collected from hospital clinical information systems and paper charts. All study outcomes will be compared between baseline (pre-implementation) and intervention (post-implementation) periods for all ICUs.

Discussion: The evaluation of the electronic medical ICU transfer tool will contribute to our understanding how computer-based structured documentation can improve communication between medical teams and potentially better patient safety.

Eligibility criteria: Inclusion Criteria:

* medical-surgical ICU patient
* ICU disposition on transfer is 'alive'
* Transfer to another patient care unit

Exclusion Criteria:

* ICU discharge to home/community residence
* ICU discharge by death

Primary outcomes:
measure: Complete and Timely ICU medical transfer of care document
timeFrame: Day 1, post patient ICU discharge
Secondary outcomes:
measure: Overall completeness of ICU medical transfer of care document
timeFrame: Day 1, post patient ICU-discharge
measure: Timeliness of ICU medical transfer of care document
timeFrame: Day 1, post patient ICU discharge
measure: Quality Ratings of ICU clinicians
timeFrame: 2 year
measure: Adverse Event
timeFrame: Post patient ICU discharge, up to 72 hours
measure: Perceptions of ICU clinicians
timeFrame: 2 year
Other outcomes:
measure: ICU Readmission
timeFrame: Post patient ICU discharge, up to 72 hours
measure: Medical Emergency Team (MET) Activation
timeFrame: Post patient ICU discharge, up to 72 hours
measure: Cardiac Arrest Event
timeFrame: Post patient ICU discharge, up to 72 hours
measure: Hospital Mortality
timeFrame: Post patient ICU discharge, up to 60 days
Locations:
city: Calgary
country: Canada
facility: Intensive Care Unit, Peter Lougheed Centre
state: Alberta
city: Calgary
country: Canada
facility: Intensive Care Unit, Foothills Medical Centre
state: Alberta
city: Calgary
country: Canada
facility: Intensive Care Unit, Rockyview General Hospital
state: Alberta
city: Calgary
country: Canada
facility: Intensive Care Unit, South Health Campus
state: Alberta
Study officials:
affiliation: University of Calgary
name: Henry T Stelfox, MD, PhD
role: PRINCIPAL_INVESTIGATOR
affiliation: Dalhouse University
name: Jeanna Parsons Leigh, PhD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Parsons Leigh J, Brundin-Mather R, Zjadewicz K, Soo A, Stelfox HT. Improving transitions in care from intensive care units: Development and pilot testing of an electronic communication tool for healthcare providers. J Crit Care. 2020 Apr;56:265-272. doi: 10.1016/j.jcrc.2020.01.019. Epub 2020 Jan 18. No abstract available.
citation: Parsons Leigh J, Brundin-Mather R, Whalen-Browne L, Kashyap D, Sauro K, Soo A, Petersen J, Taljaard M, Stelfox HT. Effectiveness of an Electronic Communication Tool on Transitions in Care From the Intensive Care Unit: Protocol for a Cluster-Specific Pre-Post Trial. JMIR Res Protoc. 2021 Jan 8;10(1):e18675. doi: 10.2196/18675.