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BackgroundOperating room to intensive care unit handoffs are high-risk events for critically ill patients. Studies in selected patient populations show that standardizing operating room to intensive care unit handoffs improves information exchange and decreases errors. To adapt these findings to mixed surgical populations, we propose to study the implementation of a standardized operating room to intensive care unit handoff process in two intensive care units currently without an existing standard process.Methods/DesignThe Handoffs and Transitions in Critical Care (HATRICC) study is a hybrid effectiveness- implementation trial of operating room to intensive care unit handoffs. We will use mixed methods to conduct a needs assessment of the current handoff process, adapt published handoff processes, and implement a new standardized handoff process in two academic intensive care units. Needs assessment: We will use non-participant observation to observe the current handoff process. Focus groups, interviews, and surveys of clinicians will elicit participants’ impressions about the current process. Adaptation and implementation: We will adapt published standardized handoff processes using the needs assessment findings. We will use small group simulation to test the new process’ feasibility. After simulation, we will incorporate the new handoff process into the clinical work of all providers in the study units. Evaluation: Using the same methods employed in the needs assessment phase, we will evaluate use of the new handoff process. Data analysis: The primary effectiveness outcome is the number of information omissions per handoff episode as compared to the pre-intervention period. Additional intervention outcomes include patient intensive care unit length of stay and intensive care unit mortality. The primary implementation outcome is acceptability of the new process. Additional implementation outcomes include feasibility, fidelity and sustainability.DiscussionThe HATRICC study will examine the effectiveness and implementation of a standardized operating room to intensive care unit handoff process. Findings from this study have the potential to improve healthcare communication and outcomes for critically ill patients.Trial registrationClinicalTrials.gov identifier: NCT02267174. Date of registration October 16, 2014.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2482-14-96) contains supplementary material, which is available to authorized users.

Recent evidence shows that emergency physicians (EP) can help patients obtain evidencebased treatment for Opioid Use Disorder by starting medication for addiction treatment (MAT) directly in the Emergency Department (ED). Many EDs struggle to provide options for maintenance treatment once patients are discharged from the ED. Health systems around the country are in need of a care delivery structure to link ED patients with OUD to care following initiation of buprenorphine. This paper reviews the three most common approaches to form effective partnerships between EDs and primary care/addiction medicine services: the Project Alcohol and Substance Abuse Services and Referral to Treatment (ASSERT) model, Bridge model, and ED-Bridge model. The ASSERT Model is characterized by peer educators or community workers in the ED directly referring patients suffering from OUD in the ED to local addiction treatment services. The Bridge model encourages prescribing physicians in an ED to screen patients for OUD, provide a shortterm prescription for buprenorphine, and then refer the patient directly to an outpatient Bridge Clinic that is co-located in the same hospital but is a separate from the ED. This Bridge Clinic is staffed by addiction trained physicians and mid-level clinicians. The ED-Bridge model employs physicians trained in both emergency medicine and addiction medicine to serve within the ED as well as in the follow up addiction clinic. Distinct from the Bridge Clinic model above, EPs in the ED-Bridge model are both able to screen at-risk patients in the ED, often starting treatment, and to longitudinally follow patients in a regularly scheduled addiction clinic. This paper provides examples of these three models as well as implementation and logistical details to support a health system to better address OUD in their communities. [

A pelvic fracture with entrapment of the urinary bladder in the fracture site is a rare pattern of injury. As the “team captains” in the trauma bay and in the care of polytraumatized patients, trauma surgeons must be aware of this entity and its implications. We report a case of acute bladder entrapment in the fracture site of a lateral compression pelvic fracture. A review of the English literature yielded four previous reports, including two patients with delayed diagnosis (Ghuman et al., 2014; Kumar et al., 1980; Wright and Taitsman, 1996; Min et al., 2010 [1–4]). Kumar and colleagues first documented bladder entrapment by a pelvic fracture in 1980 (Kumar et al., 1980 [2]). Ghuman et al. described a similar case treated with fixation of the pelvic fracture (Ghuman et al., 2014 [1]). Wright and colleagues treated a patient with bladder perforation due to entrapment diagnosed two weeks after a pelvic ring fracture (Wright and Taitsman, 1996 [3]). In this case the bladder injury was repaired, but internal fixation of the pelvis fracture was avoided due to fear of contamination. Finally, Min et al. documented a case of bladder entrapment and perforation presenting six months after non-operative management of a pelvic ring fracture. The female patient developed recurrent UTIs and dyspareunia, and imaging revealed fracture malunion with the bladder entrapped in the fracture site (Min et al., 2010 [4]). This collection of case reports demonstrates the potential for acute or delayed bladder injury even in seemingly benign pelvic fractures. A high index of suspicion is required to intervene and prevent morbidity from bladder injuries in pelvic trauma. Entrapment of the bladder may require surgical intervention even when the injury pattern would not normally dictate surgery for the pelvis or bladder alone (Bryk and Zhao, 2016 [5]). We describe the diagnosis and surgical management of bladder entrapment and present a brief review of bladder injuries associated with pelvic fractures.