Cocreating the ICU-PAUSE Tool for Intensive Care Unit-Ward Transitions

Abstract

Background: Intensive care unit (ICU)-ward patient transfers are inherently high risk, and clinician miscommunication has been linked to adverse events and negative outcomes. Despite these risks, few educational tools exist to improve resident handoff communication at ICU-ward transfer.

Objective: We used human-centered design (HCD) methods to cocreate a novel electronic health record ICU-ward transfer tool alongside Internal Medicine residents at three academic hospitals.

Methods: We conducted HCD workshops at each hospital, performing process mapping, brainstorming, and rapid prototyping. We performed thematic analysis on verbatim-transcribed workshop audio recordings to inform development and adaptation of the final resident prototype into the ICU-PAUSE tool.

Results: ICU-PAUSE focuses on reasons for ICU admission and problem-based ICU course (I); Code status, goals of care, and family contacts (C); a diagnostic pause acknowledging Uncertainty (U); Pending tests (P); Active consultants (A); high-risk medications, including medications to be Unprescribed (U); Summary of problems and to-dos (S); and a current physical Exam (E).

Conclusion: We used HCD to cocreate a novel, more user-friendly electronic ICU-ward transfer tool, ICU-PAUSE, alongside Internal Medicine trainees. Future steps will involve formal usability testing, evidence-driven implementation, and clinical evaluation of ICU-PAUSE across multiple hospitals.

Keywords: handoffs; human-centered design; qualitative research methods; quality-improvement education; transitions of care.

Figure 1.

Human-centered design phases, objectives, and example methods. Bold font indicates specific methods used for the current project. Stakeholder mapping visualizes all potential stakeholders and beneficiaries of a project and their relationships to the intervention. Challenge mapping uses insights from prior fieldwork to partition a large problem into discrete addressable subproblems and areas of potential solutions. “How might we…?” questions reframe barriers into opportunities for creative problem solving. Journey mapping visualizes each stakeholder’s external and internal interactions with a problem such that opportunities for innovation can be identified. Brainstorming involves formal exercises to generate and exchange new ideas. Storyboarding involves roughly visualizing potential innovations or solutions chronologically. Rapid prototyping involves iterative, generally low-fidelity, creation and revision of solutions developed during the ideation phase. Fake front and back ends involve creation of either user-facing (e.g., interactive screen which mirrors, but is not connected to, the her, such that user behavior can be safely observed) or developer-facing (e.g., isolated development mode to test secure login) scenarios.

Figure 2.

Proposed ICU-PAUSE electronic tool. ACP = advanced care planning; ddx = differential diagnosis; DPOA = designated power of attorney; ICU = intensive care unit; N/A = not applicable; OT = occupational therapy; PT = physical therapy; SLP = speech and language pathology; VTE = venous thromboembolism.