Impact of patient handover structure on neonatal perioperative safety

Abstract

Objective To compare the incidence, severity, preventability, and contributing factors of non-routine events - deviations from optimal care based on the clinical situation - associated with team-based, nurse-to-nurse, and mixed handovers in a large cohort of surgical neonates. Study Design A prospective observational study and one-time cross-sectional provider survey were conducted at one urban academic children’s hospital. 130 non-cardiac surgical cases in 109 neonates who received pre- and post-operative NICU care. Results The incidence of clinician-reported NREs was high (101/130 cases, 78%) but did not differ significantly across acuity-tailored neonatal handover practices. National Surgical Quality Improvement – Pediatric occurrences of major morbidity were significantly higher (p<0.001) in direct team handovers than indirect nursing or mixed handovers. Conclusions NREs occur at a high rate and are of variable severity in neonatal perioperative care. NRE rates and contributory factors were homogenous across handover types. Surveyed clinicians recommend structured handovers for all patients at every transfer point regardless of acuity.

Outcomes following the establishment of Qatar’s quaternary neonatal general surgical service in a hospital with a “Tabula Rasa” for service development

“…Postoperative handover of babies involved anesthesiologists, the neonatal surgeon, neonatologists, and the NICU team in line with best-practice international guidelines, with further modifications to ensure that the multinational team understood the handover process. [7] We believe that the strong collaboration on nutritional management of surgical babies between surgeons, neonatologists, and allied health care professionals contributed significantly to the low mortality in babies with intestinal failure, necessitating prolonged dependence on parenteral nutrition babies with short bowel syndrome and following necrotizing enterocolitis. International guidelines such as the ESPGHAN guidelines were initially proposed as the foundation for these babies' nutritional decisions.…”

Enhancing team success in the neonatal intensive care unit: challenges and opportunities for fluid teams

“…While nurse-nurse handoffs are most frequent, handoffs from labor and delivery occur at the start of an infant's stay in the NICU which is followed by multiple fluid team members from physicians, respiratory therapists, fellows, etc. contributing to the rate of patient handovers (Gephart, 2012;France et al, 2019;Cardona et al, 2021). A potential complication to patient handoffs is that the shared mental model between the fluid team during the day may not be transferred over into the night shift, and vice versa.…”

Ascertaining Design Requirements for Postoperative Care Transition Interventions

“…2 However, they can be vulnerable to communication breakdowns, technical errors, and environmental distractions, [3][4][5] leading to process failures. [6][7][8] Standardization using process-based protocols 9 and structured information transfer checklists 10 are implemented to mitigate these care transition failures. Initial evaluations suggest that these standardized strategies were successful in reducing information loss, technical errors, and process defects while increasing clinician satisfaction and teamwork.…”