Eastern association for the surgery of trauma – quality, patient safety, and outcomes committee - transitions of care: healthcare handoffs in trauma

Appelbaum, Rachel; Martín, S.; Tinkoff, Glen; Pascual, José L.; Gandhi, Rajesh R.

doi:10.1016/j.amjsurg.2021.01.034

Cited by 6 publications

(7 citation statements)

References 40 publications

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“…Care transitions after trauma can be associated with miscommunication or incomplete transfer of information,9 10 which has the potential to lead to unintentional persistent opioid prescribing or other deficiencies in post-trauma pain care. Standardization of care transitions after trauma hospitalization is currently lacking.…”

Section: Introductionmentioning

confidence: 99%

Lessons from the implementation of a trauma center-based program to support primary care providers in managing opioids and pain after trauma hospitalization

Baldwin

Katers

Sullivan

et al. 2023

Trauma Surg Acute Care Open

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BackgroundDecreasing exposure to prescription opioids is critical to lowering risk of opioid misuse, overdose and opioid use disorder. This study reports a secondary analysis of a randomized controlled trial implementing an opioid taper support program directed to primary care providers (PCPs) of patients discharged from a level I trauma center to their homes distant from the center, and shares lessons for trauma centers in supporting these patients.MethodsThis longitudinal descriptive mixed-methods study uses quantitative/qualitative data from trial intervention arm patients to examine implementation challenges and outcomes: adoption, acceptability, appropriateness, feasibility, fidelity. In the intervention, a physician assistant (PA) contacted patients after discharge to review their discharge instructions and pain management plan, confirm their PCP’s identity and encourage PCP follow-up. The PA reached out to the PCP to review the discharge instructions and offer ongoing opioid taper and pain management support.ResultsThe PA reached 32 of 37 patients randomized to the program. Of these 32, 81% discussed topics not targeted by the intervention (eg, social/financial). The PA identified and reached a PCP’s office for only 51% of patients. Of these, all PCP offices (100% adoption) received one to four consults (mean 1.9) per patient (fidelity). Few consults were with PCPs (22%); most were with medical assistants (56%) or nurses (22%). The PA reported that it was not routinely clear to patients or PCPs who was responsible for post-trauma care and opioid taper, and what the taper instructions were.ConclusionsThis level I trauma center successfully implemented a telephonic opioid taper support program during COVID-19 but adapted the program to allow nurses and medical assistants to receive it. This study demonstrates a critical need to improve care transition from hospitalization to home for patients discharged after trauma.Level of evidenceLevel IV.

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Section: Introductionmentioning

confidence: 99%

Lessons from the implementation of a trauma center-based program to support primary care providers in managing opioids and pain after trauma hospitalization

Baldwin

Katers

Sullivan

et al. 2023

Trauma Surg Acute Care Open

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“…When combined with accountability, standardization helps minimize communication errors during transfers of care. This has been shown to promote patient safety through positive responses to PSIs [ 41 ].…”

Section: Introductionmentioning

confidence: 99%

Response to patient safety incidents in healthcare settings in Ghana: the role of teamwork, communication openness, and handoffs

Poku,

Attafuah,

Anaba

et al. 2023

BMC Health Serv Res

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Background Patient safety incidents (PSIs) in healthcare settings are a critical concern globally, and Ghana is no exception. Addressing PSIs to improve health outcomes requires various initiatives to be implemented including improving patient safety culture, teamwork and communication between healthcare providers during handoffs. It is essential to acknowledge the significance of teamwork, communication openness, and effective handoffs in preventing and managing such incidents. These factors play a pivotal role in ensuring the well-being of patients and the overall quality of healthcare services. Aim This study assessed the occurrence and types of PSIs in health facilities in Ghana. It also examined the role of teamwork, handoffs and information exchange, and communication openness in response to PSIs by health professionals. Methods A cross-sectional study was conducted among 1651 health workers in three regions of Ghana. Using a multi-staged sampling technique, the Survey on Patient Safety Culture Hospital Survey questionnaire and the nurse-reported scale were used to collect the data and it was analysed by descriptive statistics, Pearson correlation, and linear multiple regression model at a significance of 0.05. Results There was a reported prevalence of PSIs including medication errors (30.4%), wound infections (23.3%), infusion reactions (24.7%), pressure sores (21.3%), and falls (18.7%) at least once a month. There was a satisfactory mean score for responses to adverse events (3.40), teamwork (4.18), handoffs and information exchange (3.88), and communication openness (3.84) among healthcare professionals. Teamwork, handoffs and information exchange and communication openness were significant predictors of response to PSIs, accounting for 28.3% of the variance. Conclusions Effective teamwork, handoffs and information exchange, and communication openness in the healthcare environment are critical strategies to enhance PSI response. Creating a culture that encourages error response through teamwork, communication and handoffs provides healthcare professionals with opportunities for learning and improving patient outcomes. Training programs should therefore target health professionals to improve patient safety and competency. Through the implementation of evidence-based practices and learning from past incidents, the healthcare system will be able to deliver safe and high-quality care to patients nationwide. Patient safety must be recognized as an ongoing process. Therefore, a meaningful improvement in patient outcomes requires all stakeholders’ commitment.

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“…Through a systematic review, they identified process standardization, team accountability, effective communication, and healthcare team culture as factors which affect handoff quality. 2 In a multicenter survey of trauma surgeons regarding handoffs, only 35% reported use of a formalized handoff at their institution. Few prospective studies exist on the topic of optimizing handoffs.…”

mentioning

confidence: 99%

Improving the Culture of Safety: A Prospective Handoff Initiative from the Operating Room to the Trauma Intensive Care Unit

Appelbaum

McCullough

Barnett³

et al. 2022

The American Surgeon

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A recent EAST publication emphasized the importance of handoffs to ensure safe and effective care for trauma patients. In this work, we evaluated our existing handoffs from the operating room (OR) to the trauma intensive care unit (TICU) and implemented a formal process at our level 1 trauma center. Pre and post-intervention surveys were offered to the stakeholders. Responses were recorded in a Likert scaled format and results were compared using Student’s t-test with statistical significance was set to .05. 57 surveys were completed (30 pre, 27 post) and 139 handoffs occurred. There was significant improvement in “overall satisfaction” and “understanding of information expected.” Standardizing an OR to intensive care unit handoff clarifies expectations and improves care team satisfaction. While future studies are needed to evaluate the impact of structured handoffs on patient outcomes, provider satisfaction likely serves as an indicator for culture shift towards safer transitions of care for injured patients.

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Eastern association for the surgery of trauma – quality, patient safety, and outcomes committee - transitions of care: healthcare handoffs in trauma

Cited by 6 publications

References 40 publications

Lessons from the implementation of a trauma center-based program to support primary care providers in managing opioids and pain after trauma hospitalization

Lessons from the implementation of a trauma center-based program to support primary care providers in managing opioids and pain after trauma hospitalization

Response to patient safety incidents in healthcare settings in Ghana: the role of teamwork, communication openness, and handoffs

Improving the Culture of Safety: A Prospective Handoff Initiative from the Operating Room to the Trauma Intensive Care Unit

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