Evidence Dissemination & Implementation

ATS ICU-PAUSE Initiative

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Interested in improving transitions of care at your hospital?
Join the ATS ICU-PAUSE Initiative

Background

The ATS was awarded a competitive grant administered by Council of Medical Subspeciality Societies and funded by the Gordon and Betty Moore Foundation to promote diagnostic excellence across medicine. This grant will fund a diverse array of projects to support the development and dissemination of resources and programs to improve the timeliness, accuracy, safety, efficiency, patient-centeredness, and equity of diagnostic outcomes for patients in the United States.

Need

The transition of patients from the intensive care unit to the hospital wards is an inherently high-risk time: patients are medically complex, diagnostic uncertainty is high, and care transfers from one team of clinicians to another. Communication around these transitions is highly variable and unstandardized (Santhosh et al, BMJ Qual Safety 2019). Moreover, critical information is often lost at the time of transfer from ICU-to-ward, resulting in adverse events and near misses (Lyons et al, AnnalsATS 2016).

In addition to patient safety and documentation concerns, concerns about equity also arise at high-risk transitions of care. The high acuity setting could inadvertently lead to diagnostic shortcuts including premature closure, anchoring bias, and implicit bias. Implicit bias in the form of stigmatizing language in the electronic health record has also been widely described (Himmelstein et al, JAMA Network Open 2022).

Overview

The ATS ICU Pause program aims to educate health care providers, including trainees, intensivists, hospitalists, and advanced practice providers around patient safety and equity in diagnosis at the time of ICU discharge. The communication framework that has been developed proposes a resident-co-created communication tool to discuss diagnostic uncertainty at transitions of care from the ICU to the ward, that is currently being implemented at multiple geographically diverse academic centers nationally (Fukui et al, JMIR Research Protocols, In press, 2023).

The ICU PAUSE is an electronic transfer tool that was cocreated with trainees at three academic medical centers to improve transitions from the ICU to the ward and explicitly include a diagnostic pause (Santhosh et al, ATS Scholar 2022).

The ATS ICU Pause program will focus on a national implementation of a standardized framework with prospective tracking of equity metrics to guard against the impact of implicit bias at the transition of care.

Thank you to the sites that are currently a part of the ATS ICU Pause initiative:

Baylor College of Medicine
Cedars-Sinai
Council of Medical Specialty Societies
Kaiser Permanente
Mercy Health
Pennsylvania State University
Rush University Medical Center
Rutgers University
Saint Louis University
The Jewish Hospital
Tulane University
University of Colorado
University of Las Vegas
University of Miami
University of Virginia
Washington University in St. Louis
Yale University 

Objectives

ATS ICU Pause program goals, include:

  • Creation of a pre-implementation educational curriculum targeting trainees, intensivists, hospitalists, and advanced practice providers regarding patients’ vulnerability to diagnostic error and implicit bias at transitions of care.
  • Broad national implementation of the ICU-PAUSE communication framework.
  • Post-implementation analysis of penetration of the intervention and equity metrics, including NLP analysis of ICU transfer summaries to assess for stigmatizing language.
  • Feedback to implementation sites regarding implementation success, equity metrics, stigmatizing language, and patient outcomes in cases labeled as “high uncertainty”.

Deliverables

The ATS will develop and disseminate CME-accredited educational modules via ATS Ed+ to trainees, intensivists, hospitalists, and advanced practice providers on creating a structured pre-implementation educational curriculum comprising multiple components with consistent branding:

  1. Two 15-minute online educational modules hosted by ATS website on patient safety and diagnostic errors at transitions of care and patients’ vulnerability to implicit bias at transitions of care.
  2. Educational toolkit on diagnostic uncertainty and implicit bias & the ICU-PAUSE, which includes an instructional video, pocket card and poster.
  3. Implement the educational curriculum and ICU-PAUSE tool at all sites (in addition to the original 10 sites).

Get Involved with ATS ICU Pause

If you are interested in having your site join the nation-wide ATS ICU Pause program, contact Lekshmi Santhosh, MD, associate professor, Pulmonary/Critical Care Medicine University of California, San Francisco at Lekshmi.santhosh@ucsf.edu or Lauren Lynch, senior director, Professional Development & Training, ATS at LLynch@thoracic.org.