A Longitudinal and Sustainability Assessment of Pediatric Interfacility Transport Handover Standardization

Abstract

Introduction: Standardization of interfacility transport handover is associated with improved shared mental model development, efficiency, and teaming. We sought to build upon previously published data by evaluating 1-year follow-up data, assessing face-validity, and describing sustainability. Methods: We performed a pre-post, retrospective cohort study in a stand-alone, tertiary, pediatric referral center for children 0–18 years of age transported to our pediatric intensive care unit, neonatal intensive care unit, or emergency department from October 2016 to November 2017. Handover was standardized using multidisciplinary checklists, didactics, and simulation. Data were collected for three 8-week periods (preintervention, postintervention, and 1-year follow-up). Outcomes included shared mental model index (shared mental model congruence expressed as an index, percent congruence regarding healthcare data), teaming data (efficiency, attendance, interruptions, interdependence), and face validity (5-point, Likert scale questionnaires). Statistics included 1-way analysis of variance, Kruskal-Wallis, chi-square, and descriptive statistics. Results: One hundred forty-eight handovers (50 preintervention, 50 postintervention, and 48 at 1-year) were observed in the emergency department (41%), pediatric intensive care unit (45%), and neonatal intensive care unit (14%). No differences were noted in demographics, diagnoses, PIM-3-ROM, length of stay, mortality, ventilation, or vasoactive use. Sustained improvements were observed in shared mental model congruence expressed as an index (38% to 82%), physician attendance (76% to 92%), punctuality (91.5% to 97.5%), interruptions (40% to 10%), provision of anticipatory guidance (42% to 85%), and handover summarization (42% to 85%, all P < 0.01). Efficiency was maintained throughout (mean duration 4.5 ± 2.1 minutes). Face validity data revealed handover satisfaction, effective communication, and perceived professionalism. Conclusions: Enhancements in teaming, shared mental model development, and face validity were achieved and sustained 1-year following handover standardization with only minimal reeducation during the study period.

Handover of Critical Patients in Urgent Care and Emergency Settings: A Systematic Review of Validated Assessment Tools

“…The initial search generated 45,543 results. After eliminating those written prior to 2015, those not written in Spanish or English, and articles that did not deal with the handover of critical patients in an emergency setting, the results were narrowed to eight [24][25][26][27][28][29][30][31]. After exhaustive reading, five were excluded [25][26][27][28]30] as the handover did not take place in the study setting.…”

“…After exhaustive reading, five were excluded [25][26][27][28]30] as the handover did not take place in the study setting. Finally, three articles [24,29,31] were included in the systematic review. The PRISMA flow diagram graphically describes the results selection process (Figure 1).…”

“…In terms of geographic location, two of the studies were carried out in the United States and the other in Saudi Arabia (Tables 2 and 3). Content validity, construct validity, and internal consistency were the most common psychometric properties [24,29,31] (Table 3). Two of the studies assessed error and reliability, criterion validity, hypothesis testing, and sensitivity [24,31].…”

“…Content validity, construct validity, and internal consistency were the most common psychometric properties [24,29,31] (Table 3). Two of the studies assessed error and reliability, criterion validity, hypothesis testing, and sensitivity [24,31]. None of the studies appreciated cross-cultural adaptation or the translation process [24,29,31].…”

“…Two of the studies assessed error and reliability, criterion validity, hypothesis testing, and sensitivity [24,31]. None of the studies appreciated cross-cultural adaptation or the translation process [24,29,31].…”