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Final IPA-NOVA visual aid provided to staff for postoperative handovers to the ICU/PACU (translated from German into English by the authors). BIS, bi-spectral index -technology used to monitor depth of anesthesiaI; CU, intensive care unit; DECT, digital enhanced cordless communication -cordless phone used for hospital communication; PONV, post-operative nausea and vomiting.
Source publication
Purpose
Standardisation of the postoperative handover process via checklists, trainings or procedural changes has shown to be effective in reducing information loss. The clinical friction of implementing these measures has received little attention. We developed and evaluated a visual aid (VA) and >1 min in situ training intervention to improve the...
Contexts in source publication
Context 1
... resultant list contained 25 specific items and a further five items labelled 'other' to mark special cases that would not be applicable to most handovers for a total of 30 items. In the third phase of VA construction, the items were grouped into a coherent chronological and semantic framework containing seven categories and an acronym was devised for mnemonic support: IPA-NOVA-Intro, Personnel, Anamnesis, Narcosis, Operation, Volume Management, Next Actions (see figure 1). Finally, the VA was then sent to all senior anaesthesiologists (n=53) of the department for final review and open commentary. ...
Context 2
... generally, the reference frames of 600 s (10 min), 6 return visits and 30 meaningful pieces of information chosen in figure 1 represent a reasonable space within which an ICU/PACU handover might take place and the overall impact of the intervention along these dimensions is encouraging. However, it should be noted that some variation will always be necessary considering individual peculiarities of the handover and patient history. ...
Citations
... The table was placed within easy reach, and both patients and staff received a brief tutorial on how to use it. Staff were also trained to encourage patients to use the table for communication and to interpret their signals accurately [6]. ...
... Studies have shown that visual aids can significantly improve patient communication and reduce anxiety in medical settings [6]. For instance, Keller et al. (2020) demonstrated that visual aids enhanced the quality and quantity of information during postoperative handovers [6]. ...
... Studies have shown that visual aids can significantly improve patient communication and reduce anxiety in medical settings [6]. For instance, Keller et al. (2020) demonstrated that visual aids enhanced the quality and quantity of information during postoperative handovers [6]. Similarly, Rose et al. (2021) emphasized the potential of visual aids in enhancing communication for patients requiring artificial airways, including those in postoperative care [1]. ...
Background. This study evaluates the Patient Assistant Graphic Table (PAGT) as an innovative communication facilitator for patients under long-term mechanical ventilation. Unlike traditional non-verbal methods, the PAGT offers a more comprehensive, patient-centered design featuring intuitive icons and captions for typical patient needs and a pain scale for precise symptom communication. Results demonstrated significant improvements in communication within the PAGT group, underscoring its potential to elevate patient care in postoperative settings, which is in line with recent evidence highlighting the efficacy of visual aids. Materials and methods. The study included 80 patients divided into two groups. The PAGT group utilized the graphic table for communication, while the control group relied on conventional methods. The effectiveness was measured using patient feedback on a 1 to 5 scale six hours after extubation, and the results were processed using descriptive and nonparametric statistics. Results. Patients using the PAGT reported higher satisfaction and effectiveness, scoring 4 points, in contrast to 2 points in the control group, echoing research that visual aids can significantly improve information transfer and communication quality. Conclusions. The PAGT is a valuable tool for enhancing patient-staff communication in postoperative care, particularly when mechanical ventilation is required.
... Early postoperative patients undergoing general anesthesia were part of the most vulnerable groups. There were numerous studies on handover from the operating room (OR) to the postanesthesia care unit (PACU) or Intensive Care Unit (ICU) (Jelacic et al., 2021;Keller et al., 2020;Lillibridge et al., 2017;Randmaa et al., 2015). Some studies had indicated that the application of structured communication tools or formal reporting methods in patient handover enhances nurses' satisfaction and the quality and safety of patient transfer between the OR and the PACU/ICU (Leonardsen et al., 2019;Nagpal et al., 2013;Talley et al., 2019). ...
Background
Early postoperative patients are vulnerable. Poor communication between health care professionals may seriously damage patients' wellbeing. There is a risk of information loss when bedside handover is performed.
Objectives
To investigate whether the implementation of structured and relayed forms to shift-to-shift bedside handovers improve the frequency of appropriate handover elements and reduces the incidence of adverse events and postoperative length of stay for patients in a postanesthesia care unit.
Methods
This quality improvement project was conducted in a postanesthesia care unit of a tertiary stomatological hospital in China. The study population was patients under surveillance in the postanesthesia care unit for >12 h. A pre- and post-implementation approach was employed. The pre-implementation of unstructured bedside handovers and the post-implementation of bedside handovers with structured and relayed forms were compared. The indicators measured were appropriate handover elements, adverse patient events, and postoperative hospital stay.
Results
There were 387 and 395 morning handovers observed pre- and post-implementation of bedside handovers with structured and relayed forms, respectively. Of the 21 elements that should be delivered, 17 elements were noted to be improved. No improvement was found in the incidence of adverse events and postoperative hospital stay.
Conclusions
Bedside handovers with structured and relayed forms increased the incidence of appropriate handover elements. The use of structured and relayed forms did not affect on the incidence of adverse events and postoperative hospital stay. Individualized relayed handover forms may be developed and implemented according to the characteristics in which they are administered.
... The COLD process used in this study addresses these concerns by integrating recommended best practices for both procedural and content aspects of handoff into a single standard process. Further, similar to a recent study (Keller, Bosse, Memmert, Treskatsch, & Spies, 2020), we demonstrated how it can be implemented using a simple visual aid with brief training for rapid adoption and consistent implementation. In contrast, previous research using similar elements to improve nurse handoff practices were typically onerous in terms of time and resources required for implementation (Marshall et al., 2019;Wong, Tung, Peck, & Goh, 2019;Yang & Zhang, 2016), and others failed to deliver the desired behaviors (Bergs et al., 2018). ...
This naturalistic, pre and post design study explored the feasibility and acceptability of a brief patient safety intervention to introduce a tool to standardize interdisciplinary communication processes at patient handoff between anaesthetists and postanaesthesia nurses in the Post Anaesthetic Care Unit. Observation and interview data were collected pre and post intervention from a convenience sample of 27 nurses and 23 anaesthetists in a large tertiary hospital in Melbourne, Australia. Following the intervention, significant improvement was observed in nurses’ performance of several patient safety behaviors, but trends in nurses’ interdisciplinary communication behaviors such as asking questions and escalation of care were non‐significant. This research provides evidence that tools to standardize clinical handoff communication may empower nurses to perform desired patient safety behaviors during inter‐professional handoff. It underpins future research to explore strategies to empower nurses to advocate for patient safety during interdisciplinary communication, and provides a foundation for patient handoff improvement, education and further research.
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BACKGROUND
Perioperative handoffs are known to present unique challenges to safe and effective patient care. Numerous national accrediting bodies have called for standardized, structured handoff processes. Handoff mnemonics provide a memory aid and standardized structure, as well as promote a shared mental model. We set out to identify perioperative handoff intervention studies that included a handoff mnemonic; critically assess process and patient outcome improvements that support specific mnemonics; and propose future recommendations.
METHODS
We conducted a systematic review of the English language perioperative handoff intervention literature designed to identify handoff mnemonic interventions. A comprehensive protocol was developed and registered (CRD42022363615). Searches were conducted using PubMed, Scopus, ERIC (EBSCO), Education Full Text (EBSCO), EMBASE (Elsevier), and Cochrane (January 1, 2010 to May 31, 2022). Pairs of trained reviewers were involved in all phases of the search and extraction process.
RESULTS
Thirty-seven articles with 23 unique mnemonics met the inclusion criteria. Most articles were published after 2015 (29/37; 78%). Situation, Background, Assessment, Recommendation (SBAR), and SBAR variants were used in over half of all studies (22/37; 59%), with 45% (10/22) reporting at least 1 statistically significant process improvement. Seventy percent of handoff mnemonics (26/37) were expanded into lists or checklists. Fifty-seven percent of studies (21/37) reported using an interdisciplinary/interprofessional team to develop the intervention. In 49% of all studies (18/37) at least 1 measurement tool was either previously published or the authors conducting some form of measurement tool validation. Forty-one percent of process measurement tools (11/27) had some form of validation. Although most studies used training/education as an implementation strategy (36/37; 97%), descriptions tended to be brief with few details and no study used interprofessional education. Twenty-seven percent of the identified studies (10/37) measured perception alone and 11% (4/37) measured patient outcomes.
CONCLUSIONS
While the evidence supporting one handoff mnemonic over others is weak, SBAR/SBAR variants have been studied more often in the perioperative environment demonstrating some process improvements. A key finding is that 70% of included studies converted their handoff mnemonic to a list or checklist. Finally, given the essential nature of effective handoffs to perioperative patient safety, it is crucial that handoff interventions are well developed, implemented, and evaluated. We propose 8 recommendations for future perioperative handoff mnemonic clinical interventions and research.
Introduction: This study aims to investigate how effective handover practices among nurses contribute to enhancing teamwork within elder care settings. It will explore the impact of clear communication, structured handover processes, and collaboration among nursing teams during handovers on various aspects of teamwork, including coordination, information sharing, and mutual support. Methods: A qualitative, descriptive study employed semi-structured interviews with nurses and other healthcare professionals involved in handover processes. Participants included nurses and various healthcare professionals. Thematic analysis, guided framework, was utilized to examine handover practices and their impact on patient care. Responses were meticulously coded manually to identify recurring themes and subthemes. Results: The study identified three key themes in healthcare handover practices: the importance of objective and clear documentation, including essential information for continuity of care, and the role of effective documentation in promoting understanding and accountability among healthcare professionals. These practices enhance communication, teamwork, and accountability, leading to improved patient outcomes. Effective communication involves aspects such as frequency, timeliness, accuracy, problem-solving, shared knowledge, goals, and mutual respect among team members, fostering a culture of teamwork and accountability that benefits both staff and patients. Conclusion: Achieving optimal teamwork in professional hierarchies requires insights and experiences on handover implementation from an interprofessional perspective. This collaborative approach involves professionals working together to provide comprehensive patient care. Interprofessional collaboration encourages effective communication, mutual respect, and shared decision-making among team members, ultimately enhancing patient outcomes.
This study aims to investigate how effective handover practices among nurses contribute to enhancing teamwork within elder care settings. It will explore the impact of clear communication, structured handover processes, and collaboration among nursing teams during handovers on various aspects of teamwork, including coordination, information sharing, and mutual support. Methods:Aqualitative, descriptive study employed semi-structured interviews with nurses and other healthcare professionals involved in handover processes. Participants included nurses and various healthcare professionals. Thematic analysis, guided framework, was utilized to examine handover practices and their impact on patient care. Responses were meticulously coded manually to identify recurring themes and subthemes.Results:The study identified three key themes in healthcare handover practices: the importance of objective and clear documentation, including essential information for continuity of care, and the role of effective documentation in promoting understandingandaccountabilityamonghealthcareprofessionals.Thesepracticesenhance communication, teamwork, and accountability, leading to improved patient outcomes. Effective communication involves aspects such as frequency, timeliness, accuracy, problem-solving, shared knowledge, goals, and mutual respect among team members, fostering a culture of teamwork and accountability that benefits both staff and patients. Conclusion:Achieving optimal teamwork in professional hierarchies requires insights and experiences on handover implementation from an interprofessional perspective. This collaborative approach involves professionals working together toprovidecomprehensivepatientcare.Interprofessionalcollaborationencourageseffective communication, mutual respect, and shared decision-making among team members, ultimately enhancing patient outcomes.
Background: Operating room (OR) to the intensive care unit (ICU) handoff standardization is a well-studied intervention to decrease preventable patient harm. We conducted a systematic review to synthesize findings about OR to ICU handoff intervention sustainability and the impact on handoff interventions on patient outcomes, neither of which are well described in recent reviews of OR to ICU handoff studies.
Methods: Inclusion criteria included full papers (i.e., not abstracts) describing original research with intervention descriptions. There were no exclusion criteria. We searched 10 electronic bibliographic databases (including PubMed, Scopus, and eight others) for studies published between 1995 and October 2021 describing OR to ICU handoffs. We used the Cochrane Consumers and Communication Review Group Study Quality Guide to present and synthesize results using the criteria pertaining to the study format and PRISMA guidelines for reporting.
Results: Our search yielded 41 papers published between 2007-2021. Thirteen (31.7%) of the studies described a sustainability period following the initial implementation phase that lasted 3-96 months. All studies with a sustainability period showed continued improvement of at least one study outcome.
Nine studies measured patient outcomes, including unplanned or early extubations, delayed dosing of antibiotics, unspecified post-surgical complications, ICU-level patient mortality, among others. Of these, 7 (77.8%) reported statistical significance improvement of patient outcomes, but none were able to establish causation. Two studies reported no difference in any patient outcomes.
Discussion: Interpretation of the evidence was limited by the risk of recall bias, Hawthorne effect, sampling bias, response bias, and no blinding of participants or personnel. Collectively, the evidence from all the studies examined is subject to both publication and selective reporting within studies.
Overall, the studies demonstrate improvement in information exchange and clinician satisfaction with standardization but have not shown to cause improvement in patient outcomes. Only a few of these studies have focused on the sustainability of handoff standardization conventions. Overall, the field is heavily dominated by cardiac research and is lacking in sustainability research and patient outcome-correlated research.
Other: Funding: The primary source of funding for this review was institutional funds.
Register name: INPLASY
Register number: INPLASY202220035
