Abstract Rationale Patients who survive critical illness are vulnerable to receiving potentially inappropriate medications at transitions of care. Gastric acid suppression medications, such as proton pump inhibitors (PPIs) and histamine-2 receptor antagonists (H2RAs), are routinely prescribed in the ICU for stress ulcer prevention. These medications, however, can often be continued when patients are transferred out of the ICU and even onto hospital discharge. Beginning in September 2024, our institution started adopting the American Thoracic Society (ATS) ICU-PAUSE electronic tool at select ICUs as the structured ICU-to-ward transfer summary to improve the handoff process. This study aims to evaluate the impact of this intervention on medication reconciliation at transitions of care. Methods We performed a retrospective cohort study with institutional IRB approval. We extracted electronic chart data for adult patients who had ICU admissions and ICU-to-ward transfers from September 2023 to July 2025. For patients who had multiple ICU admissions during the study period, we included only the index ICU admission for analysis. For each patient, we obtained baseline demographic data, ICU and hospital encounter start and end times, presence of ICU-PAUSE as transfer note, PPI and H2RA administration start and end times, and admission and discharge medications. Between patients with ICU-PAUSE transfer notes and those without, we compared their percentages of continuation of newly started gastric acid suppression medications at ICU-to-ward transfer and at hospital discharge. Chi-square test was used to analyze statistical significance. Results A total of 12,229 patients were included in the study. Among them, 1,068 had ICU-PAUSE transfer notes, while 11,161 did not have ICU-PAUSE transfer notes. At ICU-to-ward transfer, 34.0% of patients with ICU-PAUSE transfer notes had continuation of newly started PPI or H2RA medications, compared to 26.7% of patients without ICU-PAUSE transfer notes (p 0.001). At hospital discharge, 18.5% of patients with ICU-PAUSE transfer notes had continuation of newly started PPI or H2RA medications, compared to 19.1% of patients without ICU-PAUSE transfer notes (p = 0.611). Conclusion The adoption of the ATS ICU-PAUSE electronic tool paradoxically increased the continuation of gastric acid suppression medications at ICU-to-ward transfer but did not impact the continuation of gastric acid suppression medications at hospital discharge. Further research is needed to elucidate the underlying factors that drive unprescribing practice following critical illness. This abstract is funded by: None
Zhang et al. (Fri,) studied this question.