{"doi":"10.1515/dx-2023-0046","title":"Scaling up a diagnostic pause at the ICU-to-ward transition: an exploration of barriers and facilitators to implementation of the ICU-PAUSE handoff tool","abstract":"<jats:title>Abstract</jats:title>\n                  <jats:sec id=\"j_dx-2023-0046_abs_001\">\n                    <jats:title>Objectives</jats:title>\n                    <jats:p>The transition from the intensive care unit (ICU) to the medical ward is a high-risk period due to medical complexity, reduced patient monitoring, and diagnostic uncertainty. Standardized handoff practices reduce errors associated with transitions of care, but little work has been done to standardize the ICU to ward handoff. Further, tools that exist do not focus on preventing diagnostic error. Using Human-Centered Design methods we previously created a novel EHR-based ICU-ward handoff tool (ICU-PAUSE) that embeds a diagnostic pause at the time of transfer. This study aims to explore barriers and facilitators to implementing a diagnostic pause at the ICU-to-ward transition.</jats:p>\n                  </jats:sec>\n                  <jats:sec id=\"j_dx-2023-0046_abs_002\">\n                    <jats:title>Methods</jats:title>\n                    <jats:p>This is a multi-center qualitative study of semi-structured interviews with intensivists from ten academic medical centers. Interviews were analyzed iteratively through a grounded theory approach. The Sittig-Singh sociotechnical model was used as a unifying conceptual framework.</jats:p>\n                  </jats:sec>\n                  <jats:sec id=\"j_dx-2023-0046_abs_003\">\n                    <jats:title>Results</jats:title>\n                    <jats:p>Across the eight domains of the model, we identified major benefits and barriers to implementation. The embedded pause to address diagnostic uncertainty was recognized as a key benefit. Participants agreed that standardization of verbal and written handoff would decrease variation in communication. The main barriers fell within the domains of workflow, institutional culture, people, and assessment.</jats:p>\n                  </jats:sec>\n                  <jats:sec id=\"j_dx-2023-0046_abs_004\">\n                    <jats:title>Conclusions</jats:title>\n                    <jats:p>This study represents a novel application of the Sittig-Singh model in the assessment of a handoff tool. A unique feature of ICU-PAUSE is the explicit acknowledgement of diagnostic uncertainty, a practice that has been shown to reduce medical error and prevent premature closure. Results will be used to inform future multi-site implementation efforts.</jats:p>\n                  </jats:sec>","journal":"Diagnosis","year":2023,"id":628722,"datarank":0.31191623125197543,"base_score":2.0794415416798357,"endowment":2.0794415416798357,"self_citation_contribution":0.31191623125197543,"citation_network_contribution":0.0,"self_endowment_contribution":0.31191623125197543,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":7,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":null,"is_data_producer":false,"deposit_databanks":null,"is_oa":false,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":null,"fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":493929,"name":"Emily Harris","orcid":"0000-0001-8583-6939","position":1,"is_corresponding":false},{"id":1627949,"name":"Emma McCune","orcid":null,"position":2,"is_corresponding":false},{"id":233433,"name":"Elle Fukui","orcid":"0000-0002-8856-1659","position":3,"is_corresponding":false},{"id":420205,"name":"Patrick G. Lyons","orcid":"0000-0002-1557-2787","position":4,"is_corresponding":false},{"id":1627952,"name":"Juan C. Rojas","orcid":null,"position":5,"is_corresponding":false},{"id":689626,"name":"Lekshmi Santhosh","orcid":"0000-0002-9897-3462","position":6,"is_corresponding":false},{"id":1627947,"name":"Ella G. Cornell","orcid":null,"position":0,"is_corresponding":false}],"reference_count":0,"raw_metadata":{"has_enrichment":true,"resolved":true,"title":"Scaling up a diagnostic pause at the ICU-to-ward transition: an exploration of barriers and facilitators to implementation of the ICU-PAUSE handoff tool","abstract":"<jats:title>Abstract</jats:title>\n                  <jats:sec id=\"j_dx-2023-0046_abs_001\">\n                    <jats:title>Objectives</jats:title>\n                    <jats:p>The transition from the intensive care unit (ICU) to the medical ward is a high-risk period due to medical complexity, reduced patient monitoring, and diagnostic uncertainty. Standardized handoff practices reduce errors associated with transitions of care, but little work has been done to standardize the ICU to ward handoff. Further, tools that exist do not focus on preventing diagnostic error. Using Human-Centered Design methods we previously created a novel EHR-based ICU-ward handoff tool (ICU-PAUSE) that embeds a diagnostic pause at the time of transfer. This study aims to explore barriers and facilitators to implementing a diagnostic pause at the ICU-to-ward transition.</jats:p>\n                  </jats:sec>\n                  <jats:sec id=\"j_dx-2023-0046_abs_002\">\n                    <jats:title>Methods</jats:title>\n                    <jats:p>This is a multi-center qualitative study of semi-structured interviews with intensivists from ten academic medical centers. Interviews were analyzed iteratively through a grounded theory approach. The Sittig-Singh sociotechnical model was used as a unifying conceptual framework.</jats:p>\n                  </jats:sec>\n                  <jats:sec id=\"j_dx-2023-0046_abs_003\">\n                    <jats:title>Results</jats:title>\n                    <jats:p>Across the eight domains of the model, we identified major benefits and barriers to implementation. The embedded pause to address diagnostic uncertainty was recognized as a key benefit. Participants agreed that standardization of verbal and written handoff would decrease variation in communication. The main barriers fell within the domains of workflow, institutional culture, people, and assessment.</jats:p>\n                  </jats:sec>\n                  <jats:sec id=\"j_dx-2023-0046_abs_004\">\n                    <jats:title>Conclusions</jats:title>\n                    <jats:p>This study represents a novel application of the Sittig-Singh model in the assessment of a handoff tool. A unique feature of ICU-PAUSE is the explicit acknowledgement of diagnostic uncertainty, a practice that has been shown to reduce medical error and prevent premature closure. Results will be used to inform future multi-site implementation efforts.</jats:p>\n                  </jats:sec>","is_dataset_classified":null,"base_score":1.9459101490553132,"endowment":1.9459101490553132,"datacite_reuse_total":0,"file_count":0,"downloads":0,"views":0,"has_version_chain":false,"is_dataset":false,"is_oa":false,"pmid":"37598362","pmcid":null,"openalex_id":"https://openalex.org/W4386010916","authors":[],"funders":[],"total_grants":0,"fwci":2.0055,"citation_percentile":0.85995696,"influential_citations":0,"citation_trend":[{"year":2024,"count":1},{"year":2025,"count":5}],"oa_status":"closed","license":null,"oa_locations":[{"url":"https://www.degruyterbrill.com/document/doi/10.1515/dx-2023-0046/xml","host_type":"publisher"},{"url":"https://www.degruyterbrill.com/document/doi/10.1515/dx-2023-0046/pdf","host_type":"publisher"},{"url":"https://doi.org/10.1515/dx-2023-0046","host_type":"journal"},{"url":"https://pubmed.ncbi.nlm.nih.gov/37598362","host_type":"repository"}],"fields_of_study":["Hospital Admissions and Outcomes","Clinical Reasoning and Diagnostic Skills","Patient Safety and Medication Errors"],"mesh_terms":["Data Collection","Hospitals","Humans","Intensive Care Units","Medical Errors","Patient Handoff"],"keywords":["Handover","Workflow","Acknowledgement","Sociotechnical system","Standardization","Medicine","Dyad","Patient safety","Intensive care unit","Nursing","Medical emergency","Psychology","Intensive care medicine","Computer science","Health care","Knowledge management","Social psychology","Intensive Care","Diagnostic Uncertainty","Transition Of Care","Handoff Tool","Diagnostic Pause"],"sdg_mappings":[{"sdg_number":0,"sdg_label":"Quality Education"}],"linked_datasets":[],"clinical_trials":[],"software_tools":[],"database_accessions":[],"source":"live","citation_network_status":"fetched"},"created_at":"2026-08-05T14:46:46.266214Z","pmid":null,"pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}