Implementation of a postoperative handoff protocol

Abstract

Background: Standardised handoff protocols have become necessary patient safety tools in the perioperative venue. In this study, the authors took a validated standardised perioperative handoff protocol and implemented it into their institution to improve the perioperative handoff communications from the cardiac operating theatres to the ICU. Methods: This was a prospective, unblinded cross-sectional study. During a 6-week pre-intervention phase, 30 perioperative handoffs were observed and data were collected. Then a new structured hand-off protocol was implemented for one month, which focused on training all participating healthcare providers. This was followed by a post-intervention audit consisting of 30 operating room theatre-to-ICU handoffs using the same methodology as the pre-intervention period. Results: Overall attendance significantly increased from 20 to 86.7%. The percentage of parallel conversations decreased from 100% pre-intervention to 60% post-intervention (p < 0.0001). The mean number of interruptions of the anaesthesiology handoff report decreased from 3.37 to 0.77 (p < 0.0001) and of the surgery report from 1.84 to 0.27 (p < 0.0001). Information-sharing scores improved among all handoff attendees with the Overall Information Sharing Score (OISS) increasing from 51.47 to 88.24% (p < 0.0001). Conclusions: The implementation of a perioperative handoff protocol resulted in a drastic improvement in attendance, decrease in the number of interruptions, and improved information sharing. Future research should focus on patient-specific outcomes.

The impact of a bundled intrahospital transfer protocol on the safety of critically ill patients in a South African Metropolitan Hospital System

“…Structured handover is paramount, as recent local research has shown that implementing a "standardised handoff protocol" leads to fewer interruptions, improved attendance and improved information-sharing during handover to the ICU team. 23 The reduction in episodes of incomplete reversal or paralysis (5%; CI 3.4-7.1% vs 1.5%; CI 0.6-2.4%; p = 0.019) is an example of a minimised human-related risk factor. The intervention bundle managed to reduce equipment-related AEs from 5.2% (CI 3.4-8%) to 1.9% (CI 0.8-4.5%) (p = 0.03).…”

Handoffs From the Operating Room to the Intensive Care Unit After Cardiothoracic Surgery: From The Society of Thoracic Surgeons Workforce on Critical Care

“…Using a similar study design, Van Der Walt and colleagues [17] showed significant improvements after the implementation of a postoperative handoff protocol. Personnel attendance increased from 20% to 87% (p < 0.001), parallel conversations decreased from 100% to 60% (p < 0.0001), the mean number of interruptions decreased from 3.37 to 0.77 during the anesthesiologist handoff and from 1.84 to 0.27 during the surgeon handoff (p < 0.0001 for each), and the information sharing score increased from 51% to a robust 88% (p < 0.00001).…”

“…The handover protocol was designed with the help of a Formula 1 racecar team who came and observed the process and helped with the redesign. Process measures that were [19] Y Y Y N Breuer [22] Y Y Y N Catchpole [24] Y Y Y N Chenault [25] Y Y Y N Craig [26] Y N Y Y (attentiveness) Dixon [13] Y N Y N Gleicher [18] Y N Y N Hall [20] Y Y N N Joy [29] Y N Y N Karakaya [28] Y N Y N Kaufmnan [21] N Y N N Krimminger [23] Y N Y Y Manser [15] N N Y N Moon [37] N N Y N Mukhopadhyay [14] Y N N Y Northway [27] Y N N Y Petrovic [16] Y N Y N Ramasubbu [30] Y N N N Salzwedel [38] Y N N N Van der Walt [17] Y N N Y Zavalkoff [39] Y Y N N Percentage of studies reporting on measure 86 33 62 24…”

“…Finally, as alluded to above in Handoff Completeness, Van der Walt and colleagues [17] studied 60 adult cardiac ICU handovers before (n ¼ 30) or after (n ¼ 30) the implementation of a structured handover process. Process improvement was not as dramatic as that seen in other studies, largely because of a well-functioning unit before intervention.…”

Update on anesthesia management for explantation of veno-arterial extracorporeal membrane oxygenation in adult patients

“…The implementation of a standardized handover template as opposed to unstructured handovers has been shown to provide the best scenario for optimal information sharing. [65]…”