Initiative to improve patient safety and equity at the time of ICU discharge

The American Thoracic Society, together with six sites across the U.S., is launching the ATS ICU Pause Initiative to educate health care providers about patient safety and equity in diagnosis at the time of ICU discharge. The ICU Pause program was borne out of a need to improve diagnostic safety at the particularly high-risk juncture when patients are discharged from the intensive care unit to hospital wards.

"Transitioning from the ICU can be a high-risk time," said ATS member Lekshmi Santhosh, MD, MA, a pulmonologist and researcher at University of California, San Francisco who, together with colleagues, has conducted multi-site studies of ICU handoffs. "Not only is communication between treatment teams non-standardized, resulting in the loss of critical information, but there also may be significant diagnostic uncertainty, particularly related to medically-complex patients."

The results of the study and the insights from participating medical residents led to the creation of the ICU Pause, initially implemented at the Washington University in St. Louis.

"The ICU Pause is a tool designed to reduce the risks associated with the ICU to hospital ward transfer," said Dr. Santhosh. "It includes a built-in diagnostic pause, that is a deliberate opportunity for the treatment team to stop and acknowledge any uncertainty about the patient's diagnosis."

Over the next year, the ATS will develop and disseminate educational modules to support trainees, intensivists, hospitalists, nurses, advanced practice providers, and other team members.

The six sites currently implementing the ICU Pause tool are:

• Pennsylvania State University
• Kaiser Permanente-Oakland
• Rutgers University
• Cedars-Sinai
• Washington University in St. Louis
• Tulane University

"This tool has the potential to greatly improve patient outcomes," said ATS CEO Karen J. Collishaw, MPP, CAE. "The ATS is tremendously grateful to the Council of Medical Specialty Societies for the grant which will help support our efforts to reduce implicit bias as well as diagnostic uncertainty in the transition from the ICU to the ward across health systems, nationwide."

"We look forward to addressing the existing shortcomings with the help of our partnering institutions."

The work is published in the journal ATS Scholar.