Pilot Implementation of a Perioperative Protocol to Guide Operating Room-to-Intensive Care Unit Patient Handoffs
ABSTRACT Perioperative handoffs are a particularly high-risk period given patients' postprocedural physiology, their physical transport through the hospital, and the triad transfer of personnel, information, and technology. The authors piloted a new perioperative handoff process to guide patient transfers from the cardiac operating room (OR) to the cardiac surgical intensive care unit (CSICU). The aim of the study was to evaluate the impact of a standardized handoff process on patient care and provider satisfaction.
A prospective, unblinded intervention study.
A CSICU in a teaching hospital.
Two hundred thirty-eight health care practitioners during the transfer of care of 60 patients.
The implementation of a standardized handoff protocol and checklist.
After the protocol's implementation, the presence of all handoff core team members at the bedside increased from 0% at baseline to 68% after intervention. The percentage of missed information in the surgery report decreased from 26% to 16% (p = 0.03), but the percentage of missed information in the anesthesia report showed no significant change (19% to 17%, p > 0.05). Handoff satisfaction scores among intensive care unit (ICU) nurses increased from 61% to 81%. On average, the duration of handoff increased by 1 minute.
A standardized handoff protocol that guides the transfer of care from the OR team to the CSICU team can reduce the risk of missed information and improve satisfaction among perioperative providers.
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ABSTRACT: To evaluate a new perioperative handoff protocol in the adult perianesthesia care units (PACUs). Prospective, unblinded cross-sectional study. Perianesthesia care unit in a tertiary care facility serving 55,000 patients annually. One hundred three surgery patients. During a 4-week preintervention phase, 53 perioperative handoffs were observed, and data were collected daily by a trained observer. Educational sessions were conducted to train perioperative practitioners on the new protocol. Two weeks after implementation, 50 consecutive handoffs were observed, and practitioners were surveyed with the same methodology as in the preintervention phase. Type of information shared, type and duration of procedure, total duration of handoff, number and type of providers at the bedside, number of report interruptions, environmental distractions, and any other disruptive events. Observers also tracked technical/equipment problems to include malfunctioning or compromised operation of medical equipment, such as the cardiac monitor, transducer, oxygen tank, and pulse oximeter. A total of 103 handoffs were observed (53 preintervention and 50 postintervention). The mean number of defects per handoff decreased from 9.92 to 3.68 (P < .01). The mean number of missed information items from the surgery report decreased from 7.57 to 1.2 items per handoff and from 2.02 to 0.94 (P < .01) for the anesthesia report. Technical defects reported by unit nurses decreased from 0.34 to 0.10 (P = .04). Verbal reports delivered by surgeons increased from 21.2% to 83.3%. Although the mean duration of handoffs increased by 2 minutes (P = .01), the average time from patient arrival at PACU to handoff start was reduced by 1.5 minutes (P = .01). Satisfaction with the handoff improved significantly among PACU nurses. The perioperative handoff protocol implementation was associated with improved information sharing and reduced handoff defects. Copyright © 2014 Elsevier Inc. All rights reserved.Journal of Clinical Anesthesia 12/2014; 27(2). DOI:10.1016/j.jclinane.2014.09.007 · 1.21 Impact Factor
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ABSTRACT: Clinical handover is a critical moment in patient care. The authors tested the hypothesis that handover of anesthesia care is associated with increased mortality and morbidity in patients undergoing cardiac surgery. This was a single-center, retrospective cohort study of prospectively collected data. The study was conducted in a quaternary care cardiac surgery center and university research hospital. All patients undergoing cardiac surgical procedures between April 1, 1999 and October 31, 2009 were included in the study. Propensity-score matching was used to adjust for differences between patients who received intraoperative handover of anesthesia care and those who did not, and in-hospital mortality and morbidity were compared using multivariate logistic modeling. 14,421 patients met the inclusion criteria for this study; handover occurred in 966 cases (6.7%). After propensity-score matching, 7,137 patients were included for analysis. In-hospital mortality was 5.4% in the handover group and 4.0% in the non-handover group (match-adjusted odds ratio, 1.425; 95% confidence interval, 1.013-2.006; p = 0.0422); the incidence of major morbidity was 18.5% in the handover group and 15.6% in the non-handover group (match-adjusted odds ratio, 1.274; 95% confidence interval, 1.037-1.564; p = 0.0212). Handover of anesthetic care during cardiac surgery is associated with a 43% greater risk of in-hospital mortality and 27% greater risk of major morbidity. Further studies are required to explore this relationship and to systematically evaluate and improve the process of handover. Copyright © 2014 Elsevier Inc. All rights reserved.Journal of Cardiothoracic and Vascular Anesthesia 11/2014; 29(1). DOI:10.1053/j.jvca.2014.05.018 · 1.48 Impact Factor
- Journal of Cardiothoracic and Vascular Anesthesia 02/2015; 29(1):8-10. DOI:10.1053/j.jvca.2014.10.024 · 1.48 Impact Factor