{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,5]],"date-time":"2026-03-05T22:18:47Z","timestamp":1772749127182,"version":"3.50.1"},"reference-count":37,"publisher":"Georg Thieme Verlag KG","issue":"01","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Appl Clin Inform"],"published-print":{"date-parts":[[2021,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Background\u2003Handoffs or care transitions from the operating room (OR) to intensive care unit (ICU) are fragmented and vulnerable to communication errors. Although protocols and checklists for standardization help reduce errors, such interventions suffer from limited sustainability. An unexplored aspect is the potential role of developing personalized postoperative transition interventions using artificial intelligence (AI)-generated risks.<\/jats:p><jats:p>\n          Objectives\u2003This study was aimed to (1) identify factors affecting sustainability of handoff standardization, (2) utilize a human-centered approach to develop design ideas and prototyping requirements for a sustainable handoff intervention, and (3) explore the potential role for AI risk assessment during handoffs.<\/jats:p><jats:p>\n          Methods\u2003We conducted four design workshops with 24 participants representing OR and ICU teams at a large medical academic center. Data collection phases were (1) open-ended questions, (2) closed card sorting of handoff information elements, and (3) scenario-based design ideation and prototyping for a handoff intervention. Data were analyzed using thematic analysis. Card sorts were further tallied to characterize handoff information elements as core, flexible, or unnecessary.<\/jats:p><jats:p>\n          Results\u2003Limited protocol awareness among clinicians and lack of an interdisciplinary electronic health record (EHR)-integrated handoff intervention prevented long-term sustainability of handoff standardization. Clinicians argued for a handoff intervention comprised of core elements (included for all patients) and flexible elements (tailored by patient condition and risks). They also identified unnecessary elements that could be omitted during handoffs. Similarities and differences in handoff intervention requirements among physicians and nurses were noted; in particular, clinicians expressed divergent views on the role of AI-generated postoperative risks.<\/jats:p><jats:p>\n          Conclusion\u2003Current postoperative handoff interventions focus largely on standardization of information transfer and handoff processes. Our design approach allowed us to visualize accurate models of user expectations for effective interdisciplinary communication. Insights from this study point toward EHR-integrated, \u201cflexibly standardized\u201d care transition interventions that can automatically generate a patient-centered summary and risk-based report.<\/jats:p>","DOI":"10.1055\/s-0040-1721780","type":"journal-article","created":{"date-parts":[[2021,2,25]],"date-time":"2021-02-25T00:02:29Z","timestamp":1614211349000},"page":"107-115","source":"Crossref","is-referenced-by-count":19,"title":["Ascertaining Design Requirements for Postoperative Care Transition Interventions"],"prefix":"10.1055","volume":"12","author":[{"given":"Joanna","family":"Abraham","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, School of Medicine, Washington University, St. Louis, Missouri, United States"},{"name":"Institute for Informatics, Department of Medicine, School of Medicine, Washington University in St. Louis, Missouri, United States"}]},{"given":"Christopher R.","family":"King","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, School of Medicine, Washington University, St. Louis, Missouri, United States"}]},{"given":"Alicia","family":"Meng","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, School of Medicine, Washington University, St. Louis, Missouri, United States"}]}],"member":"194","published-online":{"date-parts":[[2021,2,24]]},"reference":[{"issue":"01","key":"ref1","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1213\/ANE.0b013e318253af4b","article-title":"Can we make postoperative patient handovers safer? A systematic review of the literature","volume":"115","author":"N Segall","year":"2012","journal-title":"Anesth Analg"},{"issue":"01","key":"ref2","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1097\/SLA.0b013e3181dc3656","article-title":"Postoperative handover: problems, pitfalls, and prevention of error","volume":"252","author":"K Nagpal","year":"2010","journal-title":"Ann Surg"},{"issue":"05","key":"ref3","doi-asserted-by":"crossref","first-page":"470","DOI":"10.1111\/j.1460-9592.2006.02239.x","article-title":"Patient handover from surgery to intensive care: using Formula 1 pit-stop and aviation models to improve safety and quality","volume":"17","author":"K R Catchpole","year":"2007","journal-title":"Paediatr Anaesth"},{"issue":"07","key":"ref4","doi-asserted-by":"crossref","first-page":"2109","DOI":"10.1097\/CCM.0b013e3182514bab","article-title":"Standardized postoperative handover process improves outcomes in the intensive care unit: a model for operational 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France","year":"2019","journal-title":"J Perinatol"},{"issue":"02","key":"ref9","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1097\/NCQ.0000000000000093","article-title":"Surgical suite to pediatric intensive care unit handover protocol: implementation process and long-term sustainability","volume":"30","author":"T Northway","year":"2015","journal-title":"J Nurs Care Qual"},{"issue":"01","key":"ref10","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1177\/1460458216681180","article-title":"An electronic handoff tool to facilitate transfer of care from anesthesia to nursing in intensive care units","volume":"25","author":"A CO Shah","year":"2019","journal-title":"Health Informatics J"},{"key":"ref11","doi-asserted-by":"crossref","first-page":"1062","DOI":"10.1111\/jocn.13115","article-title":"Improving the postoperative handover process in the intensive care unit of a tertiary teaching hospital","volume":"25","author":"J-G Yang","year":"2016","journal-title":"J Clin 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Karakaya","year":"2013","journal-title":"Eur J Anaesthesiol"},{"issue":"03","key":"ref23","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1097\/NCQ.0b013e31828b8c9c","article-title":"Developing a patient-centered ISHAPED handoff with patient\/family and parent advisory councils","volume":"28","author":"M A Friesen","year":"2013","journal-title":"J Nurs Care Qual"},{"issue":"01","key":"ref24","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1001\/jama.2018.18932","article-title":"Questions for artificial intelligence in health care","volume":"321","author":"T M Maddox","year":"2019","journal-title":"JAMA"},{"issue":"09","key":"ref26","doi-asserted-by":"crossref","first-page":"742","DOI":"10.1080\/10447318.2018.1488418","article-title":"Dashboards to support operational decision making in health centers: a case for role-specific design","volume":"35","author":"K Kunjan","year":"2019","journal-title":"Int J Hum Comput 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King","year":"2020","journal-title":"JAMA Netw Open"},{"key":"ref30","first-page":"343","article-title":"A factored generalized additive model for clinical decision support in the operating room","volume":"2019","author":"Z Cui","year":"2019","journal-title":"AMIA Annu Symp Proc"},{"issue":"10","key":"ref31","doi-asserted-by":"crossref","first-page":"749","DOI":"10.1038\/s41551-018-0304-0","article-title":"Explainable machine-learning predictions for the prevention of hypoxaemia during surgery","volume":"2","author":"S M Lundberg","year":"2018","journal-title":"Nat Biomed Eng"},{"issue":"07","key":"ref32","doi-asserted-by":"crossref","first-page":"616","DOI":"10.1177\/0004867415582053","article-title":"Conducting qualitative research in mental health: Thematic and content analyses","volume":"49","author":"M Crowe","year":"2015","journal-title":"Aust N Z J 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