Consensus Recommendations for the Conduct, Training, Implementation, and Research of Perioperative Handoffs

Agarwala, Aalok V.; Lane‐Fall, Meghan; Greilich, Philip E.; Burden, Amanda R.; Ambardekar, Aditee; Banerjee, Arna; Barbeito, Atílio; Bryson, Trenton D.; Greenberg, Steven; Lorinc, Amanda; Lynch, Isaac; Pukenas, Erin W.; Cooper, Jeffrey B.

doi:10.1213/ane.0000000000004118

Cited by 23 publications

(19 citation statements)

References 24 publications

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“…The previously mentioned published guidelines for postoperative handover quality involve preparation, prioritising patient tasks, standardised verbal report and allowing for questions (Agarwala et al, 2019; Pucher et al, 2015; Redley et al, 2016; Segall et al, 2012). The findings in the present study support these guidelines and further describe adaptation, patient assessments and dialogue within the team to contribute to quality.…”

Section: Discussionmentioning

confidence: 99%

“…Previously published recommendations and guidelines for postoperative patient handovers involve preparation, prioritising patient tasks before reporting, having relevant team members present, using documentation, standardisation of the handover process and allowing for questions (Agarwala et al, 2019; Barbeito et al, 2018; Pucher et al, 2015; Redley et al, 2016; Segall et al, 2012). Handover quality has also been related to teamwork and establishment of a shared understanding between the transferring and receiving healthcare professionals (Manser et al, 2010).…”

Section: Introductionmentioning

confidence: 99%

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Exploring postoperative handover quality in relation to patient condition: A mixed methods study

Reine

Aase

Ræder

et al. 2021

Journal of Clinical Nursing

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Aims and Objectives To describe postoperative handover reporting and tasks in relation to patient condition and situational circumstances, in order to identify facilitators for best practices. Background High‐quality handovers in postoperative settings are important for patient safety and continuity of care. There is a need to explore handover quality in relation to patient condition and other affecting factors. Design Observational mixed methods convergent design. Methods Postoperative patient handovers were observed collecting quantitative (n = 109) and qualitative data (n = 48). Quantitative data were collected using the postoperative handover assessment tool (PoHAT), and a scoring system assessing patient condition. Qualitative data were collected using free‐text field notes and an observational guide. The study adheres to the GRAMMS guideline for reporting mixed methods research. Results Information omissions in the handovers observed ranged from 1–13 (median 7). Handovers of vitally stable and comfortable patients were associated with more information omissions in the report. A total of 50 handovers (46%) were subjected to interruptions, and checklist compliance was low (13%, n = 14). Thematic analysis of the qualitative data identified three themes: “adaptation of handover,” “strategies for information transfer” and “contextual and individual factors.” Factors facilitating best practices were related to adaptation of the handover to patient condition and situational circumstances, structured verbal reporting, providing patient assessments and dialogue within the handover team. Conclusions The variations in items reported and tasks performed during the handovers observed were related to patient conditions, situational circumstances and low checklist compliance. Adaptation of the handover to patient condition and situation, structured reporting, dialogue within the team and patient assessments contributed to quality. Relevance to clinical practice It is important to acknowledge that handover quality is related to more than transfer of information. The present study has described how factors related to the patient and situation affect handover quality.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Exploring postoperative handover quality in relation to patient condition: A mixed methods study

Reine

Aase

Ræder

et al. 2021

Journal of Clinical Nursing

View full text Add to dashboard Cite

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“…A series of activities promoting teamwork and participatory design were central components of a 12-step implementation process (Geoffrion 2019). A modified Delphi technique incorporating the evidence-based candidate list was used to establish unit-determined handoff best practice (critical-to-quality information, tasks) (Nagpal 2011, Agarwala 2019. A series of simulations were conducted to co-create a redesigned handoff process and perform failure modes and effects analysis (FMEA) in the simulation center involving other frontline clinicians.…”

Section: Methodsmentioning

confidence: 99%

Application of a Participatory Ergonomic Approach for Scaling Handoff Redesign: A Pilot Feasibility Study

Gliga

Lynch

Preble

et al. 2020

Proceedings of the International Symposium on Human Factors and

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Transitions of care between clinical areas are potentially dangerous events in healthcare. This is especially true in high risk areas, such as between the operating room (OR) and the intensive care unit (ICU). Despite the existence of best practice guidelines for perioperative handoffs, scaling up successful pilots remains a challenge. To more effectively address this limitation, we tested the feasibility of using a participatory ergonomic approach for scaling handoff redesign and implementation in an academic medical center. A multidisciplinary unit-based change team of representatives and influencers was supported by a guidance team of leaders, coaches and subject matter experts through a structured implementation process (plan, engage, execute, reflect). The participatory design incorporated a modified Delphi technique, simulation, and facilitated debriefing to elicit feedback in multiple iterative cycles. The redesigned handoff became the preferred approach by frontline clinicians across the involved disciplines and resulted in a sustained improvement in conformance to unit-determined handoff best practices. The success of this feasibility pilot has led to the support of a diffusion pilot for scaling up handoff redesign within the health system. The study supports further investigation of using a participatory ergonomics approach to engage frontline clinicians and executive leadership to scale complex sociotechnical change, like handoffs and care transitions.

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“…In September 2017, the Anesthesia Patient Safety Foundation (APSF), in full support of the Multicenter Handoff Collaborative (MHC), hosted a perioperative handoff consensus conference 11 12 to address handoffs at a national level. Key findings were that standardized tools could help facilitate communication during handoff and that EHR systems should be used to help when possible.…”

Section: Background and Significancementioning

confidence: 99%

A Collaborative Partnership between the Multicenter Handoff Collaborative and an Electronic Health Record Vendor

et al. 2021

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Objectives The operating room is a specialized, complex environment with many factors that can impede effective communication during transitions of care between anesthesia clinicians. We postulated that an efficient, accessible, standardized tool for intraoperative handoffs built into standard workflow would improve communication and handoff safety. Most institutions now use an electronic health record (EHR) system for patient care and have independently designed intraoperative handoff tools, but these home-grown tools are not scalable to other organizations and lack vendor-supported features. The goal of this project was to create a standardized, intraoperative handoff tool supported by EHR functionality. Methods The Multicenter Handoff Collaborative, with support from the Anesthesia Patient Safety Foundation, created a working group of frontline anesthesia experts to collaborate with a development team from the EHR vendor (Epic Systems) to design a standardized intraoperative handoff tool. Over 2 years, the working group identified the critical elements for the tool and software usability, and the EHR team designed a standardized intraoperative handoff tool that is accessible to any institution using this EHR. Results The first iteration of the intraoperative handoff tool was released in August 2019, with a second version in February 2020. The tool is standardized but customizable by individual institutions. Conclusion We demonstrate that work on complex health care processes critical to patient safety, such as handoffs, can be performed on a national scale through cross-industry collaboration. Frontline experts can partner with health care industry vendors to design, build, and release a product on an accelerated timeline.

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Consensus Recommendations for the Conduct, Training, Implementation, and Research of Perioperative Handoffs

Cited by 23 publications

References 24 publications

Exploring postoperative handover quality in relation to patient condition: A mixed methods study

Exploring postoperative handover quality in relation to patient condition: A mixed methods study

Application of a Participatory Ergonomic Approach for Scaling Handoff Redesign: A Pilot Feasibility Study

A Collaborative Partnership between the Multicenter Handoff Collaborative and an Electronic Health Record Vendor

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