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

ArticleinJournal of cardiothoracic and vascular anesthesia 26(1):11-6 · September 2011with133 Reads
DOI: 10.1053/j.jvca.2011.07.009 · Source: PubMed
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.
    • "To date, studies of OR-to-ICU handoffs have focused on the effectiveness of interventions to standardize this process. However, implementing such a complex intervention (Figure 2) requires a systematic approach, including identification of local champions, [5,27] development of an acceptable protocol, [4] and clinician engagement and edu- cation [4,5,7891027]. Most published reports in this field limit description of the implementation process to a few statements in the methods sections, leaving unexplained crucial details about how to make the process actually work. "
    [Show abstract] [Hide abstract] ABSTRACT: BACKGROUND: Operating 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.
    Full-text · Article · Nov 2014
    • "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. "
    [Show abstract] [Hide abstract] ABSTRACT: Patient handoffs can look very different depending on the context, but regardless of the situation, they are a major vulnerability in patient care. The current regulations of resident work-hours have increased the frequency of handoffs, thereby increasing the risk to patients and the need to understand how to optimize the procedure. Moreover, the time pressure that many handoffs from one department to the next face pose a unique set of teamwork and communication challenges that need to be further explored. This expert panel will engage in discussion regarding the current state of medical team handoffs: in multiple contexts, how to use technology and the environment to increase their efficiency, and the role of human factors in creating a safer patient handoff.
    Full-text · Article · Oct 2014
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