Clinical handover of the critically ill postoperative patient: An integrative review

Gardiner, Therese; Marshall, Andrea P.; Gillespie, Brigid M.

doi:10.1016/j.aucc.2015.02.001

Cited by 23 publications

(19 citation statements)

References 30 publications

(80 reference statements)

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“…This is in line with an integrative review of postoperative handover showing that information transfer, technical errors and high-risk events were positively influenced by the use of structured handover tools. 27 Communication with high predictability can be said to contain redundancy, which facilitates the receiver’s interpretation of the message. 28 A third strategy was to see the benefits of cooperation between and within the teams, which is in accordance with a previous study.…”

Section: Discussionmentioning

confidence: 99%

The postoperative handover: a focus group interview study with nurse anaesthetists, anaesthesiologists and PACU nurses

Randmaa

Engström²,

Swenne

et al. 2017

BMJ Open

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ObjectivesTo investigate different professionals’ (nurse anaesthetists’, anaesthesiologists’, and postanaesthesia care unit nurses’) descriptions of and reflections on the postoperative handover.DesignA focus group interview study with a descriptive design using qualitative content analysis of transcripts.SettingOne anaesthetic clinic at two hospitals in Sweden.ParticipantsSix focus groups with 23 healthcare professionals involved in postoperative handovers. Each group was homogeneous regarding participant profession, resulting in two groups per profession: nurse anaesthetists (n=8), anaesthesiologists (n=7) and postanaesthesia care unit nurses (n=8).ResultsPatterns and five categories emerged: (1) having different temporal foci during handover, (2) insecurity when information is transferred from one team to another, (3) striving to ensure quality of the handover, (4) weighing the advantages and disadvantages of the bedside handover and (5) having different perspectives on the transfer of responsibility. The professionals’ perceptions of the postoperative handover differed with regard to temporal foci and transfer of responsibility. All professional groups were insecure about having all information needed to ensure the quality of care. They strived to ensure quality of the handover by: focusing on matters that deviated from the normal course of events, aiding memory through structure and written information and cooperating within and between teams. They reported that the bedside handover enhances their control of the patient but also that it could threaten the patient’s privacy and that frequent interruptions could be disturbing.ConclusionsThe present findings revealed variations in different professionals’ views on the postoperative handover. Healthcare interventions are needed to minimise the gap between professionals’ perceptions and practices and to achieve a shared understanding of postoperative handover. Furthermore, to ensure high-quality and safe care, stakeholders/decision makers need to pay attention to the environment and infrastructure in postanaesthesia care.

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Section: Discussionmentioning

confidence: 99%

The postoperative handover: a focus group interview study with nurse anaesthetists, anaesthesiologists and PACU nurses

Randmaa

Engström²,

Swenne

et al. 2017

BMJ Open

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“…Once the drapes were removed, too many new team members entered the room to accurately track their behavior. Postoperative handoffs are important yet they were not a goal of this study, as they have been studied meticulously elsewhere [51, 52]. …”

Section: Methodsmentioning

confidence: 99%

An Ethogram to Quantify Operating Room Behavior

et al. 2016

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Background The operating room (OR) is a highly social and hierarchical setting where interprofessional team members must work interdependently under pressure. Due primarily to methodological challenges, the social and behavioral sciences have had trouble offering insight into OR dynamics. Purpose We adopted a method from the field of ethology for observing and quantifying the interpersonal interactions of OR team members. Methods We created and refined an ethogram, a catalog of all our subjects’ observable social behaviors. The ethogram was then assessed for its feasibility and interobserver reliability. Results It was feasible to use an ethogram to gather data in the OR. The high interobserver reliability (Cohen’s Kappa coefficients of 81 % and higher) indicates its utility for yielding largely objective, descriptive, quantitative data on OR behavior. Conclusions The method we propose has potential for social research conducted in healthcare settings as complex as the OR.

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“…These studies consistently recommend the implementation of postoperative handover protocols that standardize the process, involve the completion of urgent clinical tasks before information transfer, allow only patient-specific discussions during verbal handover, and require the presence of all relevant team members during the handover process (4). The use of a structured postoperative handover process improves information transfer and reduces medical error without increasing the duration of handover (5).…”

Section: Standardizing the Postoperative Handover Process In The Picumentioning

confidence: 99%

Standardizing the Postoperative Handover Process in the PICU

Krmpotic

2015

Pediatric Critical Care Medicine

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The authors reply: W e thank Dr. Krmpotic (1) for her thoughtful commentary regarding what we strongly believe to be a key issue in the realm of patient safety. As she indicated, a number of publications highlight the persistent challenges and pitfalls faced by providers when a postoperative patient is handed over, especially in the intensive care setting. Unfortunately, such challenges far too often translate into negative consequences for the patients themselves. We completely agree that handovers, especially in such a vulnerable population, can be crucial times in a patient's hospital course. Making Standardizing the Postoperative Handover Process in the PICUTo the Editor: I n 2012, the Canadian Paediatric Adverse Events Study identified surgical patients as the most vulnerable population in academic pediatric centers (1). Surgical patients undergo multiple transitions of care during an admission to hospital, with each handover providing an opportunity for communication breakdown and medical error. Although this may occur at any point during the preoperative, intraoperative, or postoperative period, postoperative handover is often provided by the anesthesiologist in the absence of the surgeon, and deficient in the transfer of patient-specific information, procedure-specific anesthetic information, and procedurespecific surgical information (2).In a recent issue of Pediatric Critical Care Medicine, Breuer et al (3) describe the implementation of a standardized handover process for all postoperative admissions to their noncardiac PICU. Postoperative handover in the intensive care setting is a particularly vulnerable time because any number of distractions may impact the effective and complete transfer of information. A systematic review of studies examining postoperative handover in ICUs revealed that incomplete transfer of information is very common and that poor quality handover is associated with a higher frequency of adverse events (4). These studies consistently recommend the implementation of postoperative handover protocols that standardize the process, involve the completion of urgent clinical tasks before information transfer, allow only patient-specific discussions during verbal handover, and require the presence of all relevant team members during the handover process (4). The use of a structured postoperative handover process improves information transfer and reduces medical error without increasing the duration of handover (5).Although many pediatric cardiac surgery programs have described successful implementation of postoperative handover protocol for the use in the PICU, Breuer et al (3) are the first to report using a protocol in a noncardiac PICU. Key features include the use of scripted templates at the bedside, representation from all teams before initiating multidisciplinary handover, delivery of a standardized report regarding the intraoperative events and procedure by the surgeon and anesthesiologist, discussion of the patient's anticipated course and management plan, review of the admissi...

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Clinical handover of the critically ill postoperative patient: An integrative review

Cited by 23 publications

References 30 publications

The postoperative handover: a focus group interview study with nurse anaesthetists, anaesthesiologists and PACU nurses

The postoperative handover: a focus group interview study with nurse anaesthetists, anaesthesiologists and PACU nurses

An Ethogram to Quantify Operating Room Behavior

Standardizing the Postoperative Handover Process in the PICU

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