# Handoffs and Transitions in Critical Care - Understanding Scalability

> **NIH NIH R01** · UNIVERSITY OF PENNSYLVANIA · 2020 · $792,455

## Abstract

PROJECT SUMMARY:
“Handoffs and Transitions in Critical Care – Understanding Scalability (HATRICC-US)”
Modern care of the patient with acute cardiopulmonary failure requiring critical care support is marked by the
inadequate adoption and use of interventions with proven effectiveness. There is an urgent need to characterize
implementation strategies suitable for use in the fast-paced, high stakes environment of critical care; doing so
would generate a substantial public health impact by narrowing the evidence-to-practice performance gap for
these high-acuity patients. One such gap is caused by inconsistent adoption of standardized post-surgical
handoffs in U.S. hospitals, an intervention deemed high priority by the American Heart Association. In this project,
we use an evidence-based standardized protocol for patient care handoffs from the operating room (OR) to the
intensive care unit (ICU) as a model to study the uptake and use of complex sociotechnical interventions in acute
care. In previous work, our group demonstrated adoption, fidelity, and improvement in process outcomes in a
pilot 2-site study of OR-to-ICU handoff standardization. Our published work in this area builds on a base of more
than 65 published studies demonstrating the effectiveness of handoffs protocols on a range of outcomes relevant
to the care of patients with cardiopulmonary failure, including process, provider, and patient outcomes. The
proposed study is an extension of our work that will address critical knowledge gaps about implementation in
acute care by studying the implementation of a standardized handoff protocol in 12 adult and pediatric ICUs in
eight hospitals in five health systems. This pragmatic study is a Hybrid Type 2 effectiveness-implementation
study with a dual focus on demonstrating improvements in short-term patient outcomes (composite measure of
new-onset organ failure [co-primary]; adverse postoperative events) and implementation outcomes (fidelity [co-
primary]; feasibility; acceptability; appropriateness; implementation cost; and sustainment over two years). The
study integrates implementation frameworks, theories, and models with engineering approaches to workflow
evaluation, intervention adaptation, and evaluation. Our specific aims are to: (1) elucidate handoff protocol
implementation determinants using mixed-methods on-site contextual inquiry, (2) use an engineering approach
known as participatory design to adapt the handoff protocol to each ICU and use theory-based implementation
mapping to select tailored, multifaceted, multilevel implementation strategies, (3) implement handoff protocols in
stepped wedge fashion with randomized roll-out under the leadership of site based teams, and (4) use human-
centered design to create an implementation toolkit to facilitate the dissemination and use of study findings to a
broad audience. The proximate goal of this work is to determine effective approaches to implementation for
complex sociotechnical interv...

## Key facts

- **NIH application ID:** 10033248
- **Project number:** 1R01HL153735-01
- **Recipient organization:** UNIVERSITY OF PENNSYLVANIA
- **Principal Investigator:** Meghan Brooks Lane-Fall
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $792,455
- **Award type:** 1
- **Project period:** 2020-09-01 → 2025-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10033248

## Citation

> US National Institutes of Health, RePORTER application 10033248, Handoffs and Transitions in Critical Care - Understanding Scalability (1R01HL153735-01). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10033248. Licensed CC0.

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