Pilot Implementation of a Perioperative Protocol to Guide Operating Room-to-Intensive Care Unit Patient Handoffs

Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
Journal of cardiothoracic and vascular anesthesia (Impact Factor: 1.46). 09/2011; 26(1):11-6. DOI: 10.1053/j.jvca.2011.07.009
Source: PubMed


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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    • "A burgeoning literature describing various handoff protocols has emerged in the past few years, essentially flooding the field with acronym-derived handoff procedures. As of 2009, a systematic review identified 24 handoff mnemonics (e.g., SBAR, ASHICE, ISWITCH, GRRRR; Riesenberg, Leitzsch, & Little, 2009), and studies suggest that handoffs conducted utilizing a protocol (e.g., mnemonic) fair better compared to unstructured and unstandardized handoffs (e.g., Petrovic et al., 2012). However, few of these proposed handoff protocols have been developed empirically, and studies comparing protocols simultaneously remain nascent. "
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