Flexible Fidelity: Adaptation of the ICU-PAUSE Handoff Tool During Implementation Across 11 ICUs.

IMPORTANCE: Communication failures during patient handoffs from the ICU to the ward are common and negatively impact patients. Structured handoff communication tools may improve these transitions yet remain infrequently used. OBJECTIVES: Characterize local determinants of ICU-PAUSE handoff program perceived implementation success and describe adaptations made to the ICU-PAUSE tool and its implementation strategies during multicenter implementation. DESIGN, SETTING, AND PARTICIPANTS: Qualitative study in 11 academic hospitals' medical ICUs. Participants were intensive care physicians who volunteered to champion ICU-PAUSE implementation at their respective institutions. ANALYSIS: Thematic analysis of semi-structured interviews to understand determinants, artifact analysis to characterize adaptations, and retrospective post-implementation chart review of ICU-to-ward transfer notes to evaluate uptake and sustainability of the intervention. RESULTS: Participants reported fewer perceived implementation barriers than expected, with many anticipated barriers ultimately functioning as important facilitators. Eight sites (73%) modified the ICU-PAUSE electronic template and/or its implementation strategies; most of the 29 unique adaptations described by participants involved adding new content to the standard template. Noncontent adaptations were largely contextual to fit site-specific needs and facilitate tool adoption. One year after implementation, the ICU-PAUSE template was used in 75% of ICU-to-ward transfer notes analyzed. CONCLUSIONS: ICU-PAUSE is a low-barrier intervention to improve ICU-ward handoff communication. This study highlights the importance of adaptability in the success of nationally scalable implementation efforts for bundled interventions like ICU-PAUSE.