Surgical Suite to Pediatric Intensive Care Unit Handover Protocol

Northway, Tracie; Krahn, Gordon; Thibault, Kristine; Yarske, L.; Yuskiv, Nataliya; Kissoon, Niranjan; Collet, Jean‐Paul

doi:10.1097/ncq.0000000000000093

Cited by 20 publications

(22 citation statements)

References 34 publications

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“…Of the 11 included documents, six were published primary research studies [ 42 , 43 , 45 , 47 – 49 ], two were published quality improvement case studies [ 44 , 46 ], and three were unpublished quality improvement case reports [ 50 – 52 ] found from our citation searching [ 51 ] and gray literature searching [ 50 , 52 ] (Table 1 ). Of the 11 documents, seven used Lean exclusively [ 44 , 45 , 48 – 52 ]; two used Lean and Six Sigma [ 42 , 43 ]; one used a combination of Lean, Six Sigma, and the Institute for Healthcare Improvement (IHI) Model for Improvement [ 46 ]; and another used Lean with “other” QI classic methods [ 47 ]. Improvements were targeted at the meso (e.g., unit or organization level) ( n = 8) [ 42 – 49 ] and macro (e.g., policy, system) ( n = 3) [ 50 – 52 ] levels of the healthcare system.…”

Section: Resultsmentioning

confidence: 99%

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The sustainability of Lean in pediatric healthcare: a realist review

et al. 2018

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BackgroundLean is a quality improvement management system from the Toyota manufacturing industry. Since the early 2000’s, Lean has been used as an intervention for healthcare improvement. Lean is intended to reduce costs and improve customer value through continuous improvement. Despite its extensive use, the contextual factors and mechanisms that influence the sustainability of Lean in healthcare have not been well studied. Realist synthesis is one approach to “unpack” the causal explanations of how and why Lean is sustained or not in healthcare. We conducted a realist synthesis using the context (C) + mechanim (M) = outcome (O) heuristic, to further develop and refine an initial program theory with seven CMO hypotheses, on the sustainability of Lean efforts across pediatric healthcare.MethodsOur search strategy was multi-pronged, iterative, and purposeful in nature, consisting of database, gray literature, and contact with three healthcare organizations known for Lean implementation. We included primary research studies, published and unpublished case studies or reports, if they included Lean implementation with a pediatric focus and sustainability outcome. We used the Normalization Process Theory and the National Health Services Sustainability Model, an operational definition for Lean and a comprehensive definition for sustainability as guidance for data extraction and analysis. Our initial program theory with was refined using a blend of abductive and retroductive analytical processes.ResultsWe identified six published primary research studies, two published quality improvement case studies, and three unpublished quality improvement case reports. Five CMO hypotheses from our initial program theory were substantially supported after synthesis, “sense-making and value congruency,” “staff engagement and empowerment,” and the “ripple effect” or causal pathway between Lean implementation outcomes that served as facilitating or hindering contexts for sustainability. Overall, there was variation with the conceptualization and measurement of sustainability.ConclusionsThis study is the first to examine Lean sustainability in pediatric healthcare using realist methods. Future research should examine whether the predictors of implementation are the same or different to sustainability and evaluate the underlying mechanisms that influence the sustainability of Lean. There is also a need for research to develop and test conceptual models and frameworks on sustainability.Systematic review registrationPROSPERO-CRD42015032252.Electronic supplementary materialThe online version of this article (10.1186/s13643-018-0800-z) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

“…No improvement targeted the individual, micro level. Documents focused on a variety of problems, clinical ( n = 1) [ 42 ], process ( n = 2) [ 43 , 48 ], clinical and process (n = 1) [ 46 ], or process and system problems ( n = 7) [ 44 , 45 , 47 , 49 – 52 ].…”

Section: Resultsmentioning

confidence: 99%

The sustainability of Lean in pediatric healthcare: a realist review

et al. 2018

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“…25–28 One study used a conference room camera to assess end-of-the-week handoffs on Fridays between attending physicians and found that these handoffs rarely followed commonly recommended communication schemes. 25 Two studies recorded handoffs in the PACU and concluded that the use of a checklist improved OR-to-PACU handoffs and that patient information and equipment were transferred simultaneously in 65% of cases.…”

Section: Discussionmentioning

confidence: 99%

“…26,27 Only one other study has assessed OR-to-ICU handoffs; in this study, after implementing a standardized handoff protocol in a pediatric cardiac surgery ICU, the authors used video to demonstrate long-term sustainability. 28 It is notable that in all but one of these studies 28 the subjects were fully cognizant that their handoff performance was being recorded, potentially affecting their behavior and the quality of the information transmitted.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2017

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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.

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“…Other studies of implementing standardized communication processes have shown a decrease in missing items of information to be transmitted. [9][10][11] While handoffs generally aim to decrease missing information, perhaps handoff in the delivery room should aim to increase information shared beyond those elicited from the four questions suggested by NRP. Institutions may find our results useful for defining items that should be communicated at every delivery based on the frequency they are communicated at other institutions.…”

Section: Discussionmentioning

confidence: 99%