Ahmed, N.

Abstract Effective communication during handoffs and transitions of care is crucial, as over 50% of sentinel patient events are due to communication gaps, according to the Joint Commission. In our open multi-specialty Intensive Care Unit (ICU) at a tertiary care center, we noticed variability in handoff practices leading to provider dissatisfaction, delays in care and increased potential for errors. To address this, we developed and implemented a standardized handoff procedure. METHODS: A multi-disciplinary team comprised of fellow physicians, nursing and advanced practice provider (APP) leadership conducted an online anonymized baseline survey (B) in December 2023 in our open mixed ICU assessing multidisciplinary provider satisfaction in the process of transitioning patients out of the ICU. Based on this, we identified areas for improvement in the ICU transfer-out process, focusing on communication methods and handoff standardization. Between February and June 2024, we designed and posted signage near provider work areas to clearly designate the primary team based on the level of care and co-managing specialties. We also developed electronic record-based template dot phrases based on the I-PASS format to help standardize information provided during handoff, and ICU team members were educated on the use of the same. Post-implementation (PI) surveys were anonymously conducted in June 2024 to assess the impact of changes, with data analysis comparing pre- and post-implementation metrics, and regular feedback meetings facilitated iterative improvements. RESULTS: We received 40 survey responses (B =20 and PI=20). In the baseline survey, 65% identified room for improvement, particularly with the timing of provider handoffs, inconsistencies in transfer documentation, and clarity on the responsible medical team. Post-implementation survey results showed a 15% improvement with 80% reported no problems during the process, and 85% rated the clarity of the process as “very clear” and “clear,” with 15% neutral. Regarding staff communication, 90% rated it as “good” to “very good,” with 5% neutral. Dot phrase utilization was deemed “very helpful” to “helpful” by 54%, while 46% were neutral. The majority (95%) reported no challenges during the transfer-out process, and 80% were satisfied with the initiative's implementation. CONCLUSION: Our study highlights the impact of a multimodal approach in improving the process of ICU transitioning patients. We were able to improve the primary team identification with posted signage in the ICU.Using computer template-based dot phrases, we were also able to successfully improve satisfaction with the sign out process at time of transition out of the ICU level of care.