Standardized ICU to OR handoff increases communication without delaying surgery

Abstract

Purpose No studies have examined preoperative handoffs from the intensive care unit (ICU) to OR. Given the risk of patient harm, the authors developed a standardized ICU to OR handoff using a previously published handoff model. The purpose of this paper is to determine whether a standardized ICU to OR handoff process would increase the number of team handoffs and improve patient transport readiness. Design/methodology/approach The intervention consisted of designing a multidisciplinary, face-to-face handoff between sending ICU providers and receiving anesthesiologist and OR nurse, verbally presented in the I-PASS format. Anticipatory calls from the OR nurse to the ICU nurse were made to prepare the patient for transport. Data collected included frequency of handoff, patient transport readiness, turnover time between OR cases, and anesthesia provider satisfaction. Findings In total, 57 audits were completed. The frequency of handoffs increased from 25 to 86 percent ( p<0.0001) and the frequency of patient readiness increased from 61 to 97 percent ( p=0.001). There were no changes in timeliness of first start cases and no significant change in turnover times between cases. Anesthesia provider satisfaction scores increased significantly. Practical implications A standardized, team based ICU to OR handoff increased the frequency of face-to-face handoffs, patient readiness and anesthesia provider satisfaction within increasing turnover between cases. Originality/value Although studies have identified the transition of patients from the ICU to the OR as a period of increased harm, the development of a preoperative ICU to OR handoff had not been described. This intervention may be used in other institutions to design ICU to OR transitions of care.

Physician-to-Nurse Handover: A Systematic Review on the Effectiveness of Different Models

“…• I-PASS (illness severity, patient summary, action list, situation awareness and synthesis by receiver) mnemonic: a standardized template for the written or printed computerized handoff document coupled with the application of evidence-based verbal handoff processes, which are referred to by using verbal mnemonics. 33 It includes structured clinical data collection, including the following: diseases severity, Patient summary of statement, with anticipated dispositions, Action list, Situation awareness and contingency planning, Synthesis by receiver, with questions and key actions 29,36 ;…”

Transitions of Care in the Perioperative Period

“…Most published studies have focused on the OR-to-PACU and OR-to-ICU transitions. Yet, recent studies have begun to shed light on other equally as challenging transitions of care including the ICU-to-OR handoff [27].…”

“…Caruso et al studied the ICU-to-OR handoff, describing the implementation of a multidisciplinary handoff practice using similar principles to handoffs studied in other settings, including process standardization and ensuring face-to-face communication. The implementation of their handoff procedure was found to increase the percentage of ICU-to-OR handoffs occurring, increase patient preparedness, and did not postpone or delay the timing of surgery [27].…”

Introductory Chapter: Developing Patient Safety Champions

“…The HOP is also the standard operating procedure in both inpatient and outpatient medical settings, as well as during transitions between those two realms [39][40][41][42]. The HOP is highly variable and often dependent upon the provider's level of training, the scope of responsibility, area of specialty, and time constraints associated with daily workload [43][44][45]. Yet, the HOP is often overlooked as a source of miscommunication that potentiates adverse outcomes [46][47][48].…”