A Multidisciplinary Handoff Process to Standardize the Transfer of Care Between the Intensive Care Unit and the Operating Room

Abstract

Objective: Critically ill patients are at high risk for adverse events on transfer between intensive care unit and operating room. Patient safety concerns were raised within our institution during such transfers, and absence of a standardized patient handoff process was identified as an area of concern. Methods: The current state of the patient transfer processes between the intensive care units (ICUs) and the operating rooms (ORs) was mapped and failure modes were identified. A multidisciplinary team was convened and a standardized handoff process and tool (checklist) was developed. Adherence to the process and care team satisfaction was assessed at the end of a 60-day pilot period. Results: The process was successfully implemented hospital-wide covering all adult and pediatric ICUs. We observed a 90% compliance rate with ICU to the OR transfers and 95% compliance rate with transfers from OR to the ICU during the 60-day pilot period. The care team expressed overall satisfaction with the process and identified potential areas of improvement. Conclusion: A standardized patient handoff process between the ICU and the ORs can be successfully implemented in a large academic medical center. Universal application of this quality improvement tool can reduce patient harm, improve communication between providers, and enhance patient safety.

Ensuring effective patient hand overs in the perioperative setting

“…Although the key tenets for hand overs are the same across all settings, each department has its own team composition, communication methods, policies, and challenges . Perioperative hand overs can be particularly complex because they involve personnel in multiple departments, patients who typically cannot take part in the process, and a vast amount of information; the environment can be noisy and chaotic; and personnel are often concurrently providing patient care . Brown said that other complexities can include time‐management issues and variances in staff member routines.…”

“…Despite the importance of effective hand overs, failures in the process remain a common problem . Errors can include a lack of focus or structure and transmission of too much, inaccurate, incomplete, or misinterpreted information, which can ultimately result in negative patient outcomes . Evidence has suggested that standardization of the hand‐over process can increase the accuracy of the information, enhance communication among personnel, and improve patient safety …”

“…5 Errors can include a lack of focus or structure and transmission of too much, inaccurate, incomplete, or misinterpreted information, which can ultimately result in negative patient outcomes. 2,4,5 Evidence has suggested that standardization of the hand-over process can increase the accuracy of the information, enhance communication among personnel, and improve patient safety. 4,6 Recommendations AORN recommends that health care organizations assemble an interdisciplinary team to establish and implement a hand-over process in all phases and locations of patient care.…”

“…2,4,5 Evidence has suggested that standardization of the hand-over process can increase the accuracy of the information, enhance communication among personnel, and improve patient safety. 4,6 Recommendations AORN recommends that health care organizations assemble an interdisciplinary team to establish and implement a hand-over process in all phases and locations of patient care. 1 According to Mary C. Fearon, MSN, RN, CNOR, service line director for neurosciences at Eastside Health Alliance in Bellevue, Washington, this team is valuable for creating a process that has meaning for everyone.…”

“…2 Perioperative hand overs can be particularly complex because they involve personnel in multiple departments, patients who typically cannot take part in the process, and a vast amount of information; the environment can be noisy and chaotic; and personnel are often concurrently providing patient care. [2][3][4] Brown said that other complexities can include time-management issues and variances in staff member routines. "In the perioperative setting, time metrics are extremely prioritized, and staff members can feel rushed," she said.…”