Systematic review and meta-analysis of interventions for operating room to intensive care unit handoffs

Abstract

ObjectiveTo conduct a systematic review and meta-analysis to ascertain the impact of operating room (OR) to intensive care unit (ICU) handoff interventions on process-based and clinical outcomes.MethodWe included all English language, prospective evaluation studies of OR to ICU handoff interventions published as original research articles in peer-reviewed journals. The search was conducted on 11 November 2019 on MEDLINE, CINAHL, EMBASE, Scopus and the Cochrane Central Register of Controlled Trials databases, with no prespecified criteria for the type of comparison or outcome. A meta-analysis of similar outcomes was conducted using a random effects model. Quality was assessed using a modified Downs and Black (D&B) checklist.Results32 studies were included for review. 31 studies were conducted at a single site and 28 studies used an observational study design with a control. Most studies (n=28) evaluated bundled interventions which comprised information transfer/communication checklists and protocols. Meta-analysis showed that the handoff intervention group had statistically significant improvements in time to analgesia dosing (mean difference (MD)=−42.51 min, 95% CI −60.39 to −24.64), fewer information omissions (MD=−2.22, 95% CI −3.68 to –0.77), fewer technical errors (MD=−2.38, 95% CI −4.10 to –0.66) and greater information sharing scores (MD=30.03%, 95% CI 19.67% to 40.40%). Only 15 of the 32 studies scored above 9 points on the modified D&B checklist, indicating a lack of high-quality studies.DiscussionBundled interventions were commonly used to support OR to ICU handoff standardisation. Although the meta-analysis showed significant improvements for a number of clinical and process outcomes, the statistical and clinical heterogeneity must be accounted for when interpreting these findings. Implications for OR to ICU handoff practice and future research are discussed.

Standardization of Pediatric Noncardiac Operating Room to Intensive Care Unit Handoffs Improves Communication and Patient Care

“…Moreover, it is likely that the standardized handoff process improved team communication and decreased near-miss events and immediate postoperative complications. Existing literature in adult surgical patients and pediatric cardiac surgical patients supports the idea that standardized handoffs improve patient outcomes 7,22,23 . Very large, longitudinal multicenter studies are needed to determine the true impact of handoffs on short- and long-term outcomes for this specific patient population.…”

Strukturierte Patientenübergabe in Hochrisikobereichen

“…Insbesondere in den Studien mit umfangreichen Maßnahmenbündeln und Trainings bleibt die Frage offen, welche Einzelmaßnahmen tatsächlich effektiv sind [ 19 , 24 , 26 ]. Insgesamt kommen aktuelle Arbeiten zu dem Ergebnis, dass die Heterogenität und Qualität der verfügbaren Studien die Zusammenführung in eine hochwertige Metaanalyse derzeit nicht zulassen [ 1 , 15 ].…”

Readiness for transfer: a mixed-methods study on ICU transfers of care

“… 11–14 In OT to ICU transfer protocols, five phases were identified (pretransfer preparation, transfer and set-up, pre-report preparation, OT to ICU handoff report communication and post-report discussion) across 32 studies in a systematic review. 5 However, no study included all five phases of the protocol. 5 Consequently, avoidable technical errors, such as the absence of critical equipment for the ICU admission, were reported with standardised protocols.…”