Leveraging Telemedicine Infrastructure to Monitor Quality of Operating Room to Intensive Care Unit Handoffs

Abstract

Purpose To analyze in-room video recordings of operating room (OR) to intensive care unit (ICU) handoffs to determine tempo and quality of team interactions on nights and weekends compared with weekdays, and to demonstrate how existing telemedicine technology can be used to evaluate handoffs. Method This prospective observational study of OR-to-ICU bedside handoffs was conducted in the surgical ICU of the Hospital of the University of Pennsylvania in July 2014–January 2015. Handoff video recordings were obtained for quality improvement purposes using existing telemedicine cameras. Evaluators used adapted validated in-person assessment measures to analyze basic characteristics and quality measures (timing, report types, report duration, presence of physical exam, teamwork skills, engagement, report delivery skills, listening skills, interruptions, unprofessional comments or actions). Results Sixteen weekday and 16 night and weekend handoffs were compared. There were no significant differences in basic characteristics. Most quality measures were similar on weekdays compared with nights and weekends. Surgeons demonstrated better report delivery skills and engagement on nights and weekends (P = .002 and P = .04, respectively), whereas OR anesthesiologists’ scores were similar during both time frames. Conclusions This study presents a novel approach of assessing handoff quality in OR-to-ICU handoffs using an existing telemedicine infrastructure. Using this approach, quality measures of night and weekend handoffs were found to be no worse— and sometimes better—than those during weekdays. Video analysis may emerge as an ideal unobtrusive quality improvement methodology to monitor handoffs and improve education and compliance with institutional handoff policies.

Investigating Weekend Effect in the Management of Upper and Lower Extremity Degloving Injuries

“… 48 One study used video analysis of handoffs and found that surgeon handoffs are actually better on nights and weekends than on weekdays. 49 Unobtrusive methods like video analysis may inform targeted changes to care protocols that alleviate observed weekend effects.…”

Formulating Telemedicine Strategies in Isfahan University of Medical Sciences

“…It may be explained with the findings of Barry and Capozzi. They believe that using existing organizational infrastructure improves education, compliance with institutional handoff policies, and tele-monitoring services ( 36 , 37 ). Also, according to Saghaeiannejad-Isfahani et al, the implementation of telemedicine involves improving the technical infrastructure ( 34 ).…”

Technology Innovations in Anesthesiology

“…47 In summary, trends toward automation and algorithmic clinical and operational decision-support systems are strongly evident in most health care practices, including anesthesiology. 48 In the future, as troves of data are generated from electronic records, notes, images, sensors and devices, it will become imperative for health care systems to employ AI-enabled technologies to help clinicians and researchers develop greater insights from these multidimensional data sets in order to improve monitoring, diagnostics, and therapies in patient care. While technology innovations are likely to have a significant impact on anesthesiology practices, challenges in adoption remain and will require focused attention.…”