Evaluating the Effectiveness of an Electronic Medical Transfer Tool to Improve Communication During Transfers From ICU

NCT03590002 | Completed

• 1 other identifier: 17-2317
• Study Type: interventional
• Target: 1,751
• Locations: 1 country
• Sites: 4

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).

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

Outcome Measures

Primary Outcomes (1)

• Complete and Timely ICU medical transfer of care document

  Binary measure of the presence/absence of two conditions (1) presence of four essential information elements in ICU transfer document (GOC designation, diagnosis, active health issues, and active medications), and (2) availability of the document to accepting medical team at the time of patient transfer. Both conditions must be met to be coded as present.

  Day 1, post patient ICU discharge

Secondary Outcomes (5)

• Overall completeness of ICU medical transfer of care document

  Day 1, post patient ICU-discharge

• Timeliness of ICU medical transfer of care document

  Day 1, post patient ICU discharge

• Quality Ratings of ICU clinicians

  2 year

• Adverse Event

  Post patient ICU discharge, up to 72 hours

• Perceptions of ICU clinicians

  2 year

Other Outcomes (4)

• ICU Readmission

  Post patient ICU discharge, up to 72 hours

• Medical Emergency Team (MET) Activation

  Post patient ICU discharge, up to 72 hours

• Cardiac Arrest Event

  Post patient ICU discharge, up to 72 hours

Study Arms (2)

Electronic ICU Medical Transfer Tool

EXPERIMENTAL

ICUs allocated to the experimental arm will have access to the electronic Medical Transfer of Care Documentation Tool within the clinical information system (CIS) in order to prepare ICU transfer of care documents for the receiving medical care team.

Device: Electronic ICU Medical Transfer Tool

Dictated ICU Medical Transfer

NO INTERVENTION

Usual Care, ICUs in the control group will only have access to the dictation documentation system as the standard method to prepare ICU medical transfer documents. New ICU medical staff responsible for preparing transfer documents will receive the usual training on the dictation system.

Interventions

Electronic ICU Medical Transfer Tool DEVICE

Patient transfers of care from the ICU to inpatient wards prepared using the electronic ICU medical transfer tool within the health zone's clinical information system, Sunrise Clinical Manager.

Also known as: ICU Transfer Tool, ICU Medical Transfer Summary

Electronic ICU Medical Transfer Tool

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

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

You may not qualify if:

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

Sponsors & Collaborators

• Henry T. Stelfox, MD PhD: lead
• Canadian Frailty Network: collaborator
• Alberta Health services: collaborator
• Canadian Institutes of Health Research (CIHR): collaborator

Study Sites (4)

Intensive Care Unit, Peter Lougheed Centre

Calgary, Alberta, T1Y 6J4, Canada

Location

Intensive Care Unit, Foothills Medical Centre

Calgary, Alberta, T2N 2T9, Canada

Location

Intensive Care Unit, Rockyview General Hospital

Calgary, Alberta, T2V 1P9, Canada

Location

Intensive Care Unit, South Health Campus

Calgary, Alberta, T3M 1M4, Canada

Location

Related Publications (2)

• 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.

  PMID: 31986370 BACKGROUND

• 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.

  PMID: 33416509 BACKGROUND

MeSH Terms

Conditions

Critical Illness

Condition Hierarchy (Ancestors)

Disease Attributes; Pathologic Processes; Pathological Conditions, Signs and Symptoms

Study Officials

• Henry T Stelfox, MD, PhD

  University of Calgary

  PRINCIPAL INVESTIGATOR

• Jeanna Parsons Leigh, PhD

  Dalhouse University

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: CROSSOVER
• Sponsor Type: OTHER
• Responsible Party: SPONSOR INVESTIGATOR
• PI Title: Professor

Model Details: 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.

Study Record Dates

• First Submitted: May 29, 2018
• First Posted: July 18, 2018
• Study Start: July 30, 2018
• Primary Completion: September 9, 2020
• Study Completion: September 15, 2021
• Last Updated: October 12, 2021

Record last verified: 2021-10

Data Sharing

• IPD Sharing: Will share
• Shared Documents: STUDY PROTOCOL, SAP
• Time Frame: To be determined once the DDMS is developed.
• Access Criteria: To be determined once the DDMS is developed.

Locations

CA (4)