Table 1.

Residents’ desired elements for an intensive care unit–ward handoff tool

Themes	Subthemes	Representative Quotations
Synthesizing information and communicating clinicians' reasoning	Clear description of patient course	“There are hopefully no mysteries.”
	Prioritization of problems and tasks	“If I were receiving a patient, the to-dos and the pending stuff is more important to me than the tubes/lines/drains.”
	Action items and pending studies	“I like the prompts for the categories for the pending tests. That’s definitely something that can get lost.”
	Explicit contingency planning and anticipatory guidance	“I feel like there’s something that's missing that’s saying contingency plans, like oh, heads up, this patient is different from others and when those things happen, you should do this.”
	ACP	“If the ICU team has an ACP note, to point to it and make sure that it’s updated before transition prevents a lot of duplication of records.”
	Medications	“I always liked the ‘changes to home meds’ part...long-time home meds get held and then that’s forgotten on the floor and then it comes to discharge on the floor and you are like, why were we holding this in the first place?”
	Visualization (graphical timeline)	“I think this timeline would also be helpful not just for when you’re signing out to the primary team on the floor, but as coming back from when you're switching from days to nights or nights to days. Oftentimes you come in to patients that have been there for 24–48 h. So, I feel like this would be a concise way for you to quickly grasp what has really happened to that patient in kind of a snapshot view instead of clicking through Epic and looking through all the notes and trying to piece it together that way.”
	Illness severity during ICU stay	“What was their max dose of pressor and when were they on it? That can be really challenging to figure out if they've had an extended ICU stay. It’s also very clinically relevant on the floor to know how sick they got.”
	Vital contact information	“Right now what we have is the main person that we’ve been updating every day, since we do have to update families over the phone, and they can’t be there.”
Customizable electronic health record integration to minimize clicks	Customizable	“If you could have a master document where you could customize what was where then, so things were pulled in but only used if you really wanted them, and certain sections could be expanded if you were using it for rounding or for team communication and then collapsed or minimized if you didn’t think they were essential…. Being able to drag, resize, and collapse could help it be more multifunctional.”
	Multifunctionality	“I feel like the more functions a document serves, you use it for day-to-day handoffs between providers and for sign-out, etc., and for rounds, the more likely it is to be, to maintain in a way that is useful.”
	Reliability of information	“The less clunky it is, the easier it is to use… the more likely information is to be accurate.”
	Autopopulates text	“Do you think that this auto-importing loses some of the analysis and synthesis of being a physician and writing this yourself? I think some of the autoimporting is at risk of losing some of the credibility that you have of physically typing it.”
	Expandable for details	“It should expand and collapse based on what you put inside it.”
Standardization to reduce errors of omission	Standardizing content to save time	“I think if we’re going to ask people to write summaries, which I think we should, a lot of the rest of this stuff you have listed here should be as dropdown or as auto-populated as possible, just for time’s sake. That's a lot of work for a transfer note.”
	Explicit communication about family updates	“In terms of workflow, there should be...the ICU team, if they’re primary, should be calling the families and saying, just like we're updating every day, and saying, ‘today they’re transferring out of the ICU. You will receive a call from a different team.’ So there's no break in the communication.”
	Standardized information visible to all stakeholders	“I really like this as a way to short circuit that…. It’s just a nice way to get everyone on the same page before they leave.”
	Oversight from senior team members	“Maybe it’s something that the more experienced person on the team will be the person to be in charge of it every day and make sure it’s updated. So the senior, if they're supervising two interns, that will be maybe part of their job on a shift is just to run through those handovers and make sure they're up to date, and that unnecessary information has been removed and that they’re relatively streamlined.”

Definition of abbreviations: ACP = advanced care planning; ICU = intensive care unit.