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Baldwin CA, Krumm AM. Leveraging Consistent Communication Tools and Organizational Values to Promote Accountability Among Health Care Providers. AORN J 2024; 120:144-154. [PMID: 39189812 DOI: 10.1002/aorn.14204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 04/01/2024] [Accepted: 04/18/2024] [Indexed: 08/28/2024]
Abstract
Teamwork and effective communication between all health care staff members are essential to providing safe, high-quality patient care. High-reliability organizations align behavioral expectations with organizational values and prioritize safety over other performance metrics and pressures. Communication breakdowns, such as inadequate or incomplete information shared between caregivers, continues to be an issue that is linked to errors and staff member dissatisfaction. Initiatives to improve health care communication and improve patient outcomes are well documented, yet communication issues in the health care setting continue. An organization's credo defines its values and behavioral expectations. Educating team members on an organization's credo creates accountability among those teams to align their behavior with the organization's values, policies, and professional commitment. A Coworker Observation Reporting System offers a communication method for providing meaningful feedback on behaviors inconsistent with an organization's credo.
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Hostettler LD, Kline DM, Moore JB, Nightingale CL, Miller PR, Nunn AM, Carmichael SP. Evaluation of a Novel Emergency General Surgery Handover: A Prospective Feasibility Study. J Surg Res 2024; 302:715-723. [PMID: 39214063 DOI: 10.1016/j.jss.2024.07.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 07/18/2024] [Accepted: 07/27/2024] [Indexed: 09/04/2024]
Abstract
INTRODUCTION High-quality health information handovers are critical to optimal patient care and trainee education. The purposes of this study were to assess the feasibility of implementing an emergency general surgery (EGS) morning handover and to explore its impact upon markers of clinical care. METHODS This prospective feasibility study was conducted at a single academic tertiary-care medical center following implementation of a novel EGS morning handover process. We assessed organizational perspective through a two-part anonymous survey delivered to the EGS service staff (n = 29) and collected feasibility metrics daily at the morning handover meetings. Exploratory clinical metrics of quality improvement were compared between parallel 5-month periods preimplementation and postimplementation of the handover. Data were compared by descriptive statistics. RESULTS One hundred and seventeen patients from March 1, 2022, to July 31, 2022, and 185 patients from March 1, 2023, to July 31, 2023, were identified prehandover and posthandover implementation, respectively, with an increase in time to operating room posting by 49% (95% confidence interval [CI]: 1.03-2.14) and no statistically significant change in length of stay. The average duration of the formalized EGS morning handover was 14 min (95% CI: 12:18-15:42) having an average of 12 questions asked (95% CI: 9.98-14.02) and an average attendance of 70% from essential personnel. Eighty-four percent of postimplementation survey responses indicated positive regard toward the new EGS handover. CONCLUSIONS The implementation of an EGS morning handover is feasible, necessitating further studies to define the impact of the EGS morning handover upon clinical outcomes.
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Affiliation(s)
| | - David M Kline
- Division of Public Health Sciences, Department of Biostatistics and Data Science, WFUSM, Winston-Salem, North Carolina
| | - Justin B Moore
- Division of Public Health Sciences, Department of Implementation Science, WFUSM, Winston-Salem, North Carolina; Division of Public Health Sciences, Department of Epidemiology & Prevention, WFUSM, Winston-Salem, North Carolina
| | - Chandylen L Nightingale
- Division of Public Health Sciences, Department of Social Sciences and Health Policy, WFUSM, Winston-Salem, North Carolina
| | - Preston R Miller
- Department of Surgery, Wake Forest University School of Medicine (WFUSM), Winston-Salem, North Carolina
| | - Andrew M Nunn
- Department of Surgery, Wake Forest University School of Medicine (WFUSM), Winston-Salem, North Carolina
| | - Samuel P Carmichael
- Department of Surgery, Wake Forest University School of Medicine (WFUSM), Winston-Salem, North Carolina
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Saha AK, Segal S. A Quality Improvement Initiative to Reduce Adverse Effects of Transitions of Anesthesia Care on Postoperative Outcomes: A Retrospective Cohort Study. Anesthesiology 2024; 140:387-398. [PMID: 37976442 DOI: 10.1097/aln.0000000000004839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
BACKGROUND An intraoperative transfer of care from one anesthesia provider to another, or handover, may result in information loss and contribute to adverse patient outcomes. In 2019 the authors undertook a quality improvement effort to increase the use of a structured intraoperative handover tool incorporated in the electronic medical record. The authors hypothesized that intraoperative handovers of anesthesia care would be associated with adverse patient outcomes, and that increased use of a structured tool would attenuate this effect. METHODS This study included adult patients undergoing noncardiac surgery of at least 1 h duration performed during the period 2016 to 2021. Cases with a handover were identified if either there was a change of attending anesthesiologist or change of nurse anesthetist or resident for more than 35 min. The primary outcome was the occurrence of a composite of postoperative mortality and major postoperative morbidity. The effect of the intervention was analyzed by examining the quarterly change in odds ratio for the primary outcome for cases with and without a handover. RESULTS A total of 121,077 cases, 40.4% of which had a handover, were included. After weighting, the composite outcome was statistically associated with handovers (3,517 of 48,986 [7.2%] in handover cases vs. 4,470 of 72,091 [6.2%] in nonhandover cases; odds ratio, 1.08; 95% CI, 1.04 to 1.12). Time series analysis showed a marked increase in usage of the structured tool after the initial intervention. The odds ratio for the composite outcome showed a significant decrease over time after the initial intervention (t = -3.97; P < 0.001), with the slope of the odds ratio versus time curve decreasing from 0.002 (95% CI, 0.001 to 0.004; P = 0.018) to -0.011 (95% CI, -0.01 to -0.018; P < 0.001). CONCLUSIONS Intraoperative handovers are significantly associated with adverse outcomes even after controlling for multiple confounding variables. Use of a structured handover tool during anesthesia care may attenuate the adverse effect. EDITOR’S PERSPECTIVE
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Affiliation(s)
- Amit K Saha
- Department of Anesthesiology, and Perioperative Outcomes and Informatics Collaborative, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Scott Segal
- Department of Anesthesiology, and Perioperative Outcomes and Informatics Collaborative, Wake Forest University School of Medicine, Winston-Salem, North Carolina
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Green A, Simmons VC, Taicher BM, Thompson JA, Manske B, Funk E. Sustainability of an Operating Room to Pediatric Postanesthesia Care Unit Handoff Tool. J Perianesth Nurs 2023; 38:851-859.e2. [PMID: 37589633 DOI: 10.1016/j.jopan.2022.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 12/07/2022] [Accepted: 12/11/2022] [Indexed: 08/18/2023]
Abstract
PURPOSE The purpose of this quality improvement (QI) project was to reintroduce and assess the feasibility of a standardized, electronic health record (EHR) handoff tool and to evaluate the sustainability of a structured, team-based approach in a pediatric postanesthesia care unit (PACU). DESIGN This QI project used an observational pre-post design using two separate convenience samples of handoffs and perianesthesia providers. METHODS A standardized EHR handoff tool was reintroduced for operating room to pediatric PACU handoff communication. Handoffs between anesthesia providers, surgery team members, and PACU nurses were observed pre- and postreintroduction of the EHR handoff tool. Anesthesia providers and PACU RNs received training for giving and receiving handoffs and were provided directions on locating the EHR handoff tool. A bedside audit of items communicated for the six handoff phases (introductions, situation, background, assessment, recommendations, and questions), handoff duration, team member participation, and handoff tool utilization were performed for 149 handoffs pre- and 146 handoffs postimplementation. To evaluate sustainability, the audits were compared to postimplementation data from the 2014 pilot handoff project. FINDINGS Following reintroduction, EHR handoff tool use increased from 4% to 19%. There was a statistically significant increase in items communicated for three of the six handoff phases when using the EHR tool (P < .05). There was no statistically significant increase in handoff duration (mean = 3.66 minutes, SD = 1.57 minutes) with the EHR handoff tool. Surgical team member presence for the team-based handoff increased from 90.7% pre to 95.9% post. Provider compliance with the team-based handoff approach, which includes a PACU RN, surgical team member, and anesthesia team member present for handoff, was sustained and increased 6 years postimplementation. Feedback from anesthesia providers and PACU RNs indicated mixed reports of satisfaction with the EHR tool, perceived handoff efficiency, and consistency in both giving and receiving handoff. Adherence to five of the six structured handoff phases, except introductions, was sustained and even improved 6 years following implementation. CONCLUSIONS Evidence-based practice for handoff communication supports the use of a team approach and standardized EHR handoff tools. The reintroduction of a standardized EHR handoff tool improved the completeness of information transfer, yet did not lead to widespread adoption nor improved user satisfaction. There is an ongoing need to identify adoptable and sustainable perioperative handoff methods.
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Affiliation(s)
| | | | | | | | | | - Emily Funk
- Duke University School of Nursing, Durham, NC; Duke University Medical Center, Durham, NC.
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Evaluating Patient Identification Practices During Intrahospital Transfers: A Human Factors Approach. J Patient Saf 2023; 19:117-127. [PMID: 36170519 DOI: 10.1097/pts.0000000000001074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Reliable patient identification is essential for safe care, and failures may cause patient harm. Identification can be interfered with by system factors, including working conditions, technology, organizational barriers, and inadequate communications protocols. The study aims to explore systems factors contributing to patient identification errors during intrahospital transfers. METHODS We conducted a qualitative study through direct observation and interviews with porters during intrahospital patient transfers. Data were analyzed using the Systems Engineering Initiative for Patient Safety human factors model. The patient transfer process was mapped and compared with the institutional Positive Patient Identification policy. Potential system failures were identified using a Failure Modes and Effects Analysis. RESULTS A total of 60 patient transfer handovers were observed. In none of the evaluable cases observed, patient identification was conducted correctly according to the hospital policy at every step of the process. The principal system factor responsible was organizational failure, followed by technology and team culture issues. The Failure Modes and Effects Analysis methodology revealed that miscommunication between staff and lack of key patient information put patient safety at risk. CONCLUSIONS Patient identification during intrahospital patient transfer is a high-risk event because several factors and many people interact. In this study, the disconnect between the policy and the reality of the workplace left staff and patients vulnerable to the consequences of misidentification. Where a policy is known to be substantially different from work as done, urgent revision is required to eliminate the serious risks associated with the unguided evolution of working practice.
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Schiavi A, Hong Mershon B, Gottschalk A, Miller CR. Measurement of Information Transfer During Simulated Sequential Complete Shift-to-Shift Intraoperative Handoffs. Mayo Clin Proc Innov Qual Outcomes 2022; 7:9-19. [PMID: 36545440 PMCID: PMC9762072 DOI: 10.1016/j.mayocpiqo.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Objective To determine information transfer during simulated shift-to-shift intraoperative anesthesia handoffs and the benefits of using a handoff tool. Patients and Methods Anesthesiology residents and faculty participating in simulation-based education in a simulation center on April 6 and 20, 2017, and April 11 and 25, 2019. We used a fixed clinical scenario to compare information transfer in multiple sequential simulated handoff chains conducted from memory or guided by an electronic medical record generated tool. For each handoff, 25 informational elements were assessed on a discrete 0-2 scale generating a possible information retention score of 50. Time to handoff completion and number of clarifications requested by the receiver were also determined. Results We assessed 32 handoff chains with up to 4 handoffs per chain. When both groups were combined, the mean information retention score was 31 of 50 (P<.001) for the first clinician and declined by an average of 4 points per handoff (P<.001). The handoff tool improved information retention by almost 7 points (P=.002), but did not affect the rate of information degradation (P=.38). Handoff time remained constant for the intervention group (P=.67), but declined by 2 minutes/handoff (P<.001) in the control group, which required 7 more clarifications/handoff (P=.003). In the control group, 7 of 16 (44%) handoff chains contained one or more information retention scores below the lowest score of the entire intervention group (P=.007). Conclusion Clinical handoffs are accompanied by degradation of information that is only partially reduced by use of a handoff tool, which appears to prevent extremes of information degradation.
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Affiliation(s)
- Adam Schiavi
- Correspondence: Address to Adam Schiavi, PhD, MD, Department of Anesthesiology and Critical Care Medicine, 600 N. Wolfe Street, Phipps 455, Baltimore, MD 21287.
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France DJ, Schremp E, Rhodes EB, Slagle J, Moroz S, Grubb PH, Hatch LD, Shotwell M, Lorinc A, Robinson J, Crankshaw M, Newman T, Weinger MB, Blakely ML. A pilot study to determine the incidence, type, and severity of non-routine events in neonates undergoing gastrostomy tube placement. J Pediatr Surg 2022; 57:1342-1348. [PMID: 34839947 PMCID: PMC9050962 DOI: 10.1016/j.jpedsurg.2021.10.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 10/13/2021] [Accepted: 10/20/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Non-routine events (NRE) are defined as any suboptimal occurrences in a process being measured in the opinion of the reporter and comes from the field of human factors engineering. These typically occur well up-stream of an adverse event and NRE measurement has not been applied to the complex context of neonatal surgery. We sought to apply this novel safety event measurement methodology to neonates in the NICU undergoing gastrostomy tube placement. METHODS A prospective pilot study was conducted between November 2016 and August 2020 in the Level IV NICU and the pediatric operating rooms of an urban academic children's hospital to determine the incidence, severity, impact, and contributory factors of clinician-reported non-routine events (NREs, i.e., deviations from optimal care) and 30-day NSQIP occurrences in neonates receiving a G-tube. RESULTS Clinicians reported at least one NRE in 32 of 36 (89%) G-tube cases, averaging 3.0 (Standard deviation: 2.5) NRE reports per case. NSQIP-P review identified 7 cases (19%) with NSQIP-P occurrences and each of these cases had multiple reported NREs. One case in which NREs were not reported was without NSQIP-P occurrences. The odds ratio of having a NSQIP-P occurrence with the presence of an NRE was 0.695 (95% CI 0.06-17.04). CONCLUSION Despite being considered a "simple" operation, >80% of neonatal G-tube placement operations had at least one reported NRE by an operative team member. In this pilot study, NRE occurrence was not significantly associated with the subsequent reporting of an NSQIP-P occurrence. Understanding contributory factors of NREs that occur in neonatal surgery may promote surgical safety efforts and should be evaluated in larger and more diverse populations. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Daniel J. France
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA,Center for Research and Innovation in Systems Safety, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Emma Schremp
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA,Center for Research and Innovation in Systems Safety, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Evan B. Rhodes
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA,Center for Research and Innovation in Systems Safety, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jason Slagle
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA,Center for Research and Innovation in Systems Safety, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sarah Moroz
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA,Center for Research and Innovation in Systems Safety, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Peter H. Grubb
- Department of Pediatrics, Division of Neonatology, University of Utah, Salt Lake City,UT,USA
| | - Leon D. Hatch
- Department of Pediatrics, Division of Neonatology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Matthew Shotwell
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Amanda Lorinc
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA,Center for Research and Innovation in Systems Safety, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jamie Robinson
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA,Department of Pediatric Surgery, Monroe Carell Jr. Children’s Hospital at Vanderbilt, TN, USA
| | - Marlee Crankshaw
- Neonatal Intensive Care Unit, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, TN, USA
| | - Timothy Newman
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA,Center for Research and Innovation in Systems Safety, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Matthew B. Weinger
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA,Center for Research and Innovation in Systems Safety, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Martin L. Blakely
- Department of Pediatric Surgery, Monroe Carell Jr. Children’s Hospital at Vanderbilt, TN, USA
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Kennedy-Metz LR, Barbeito A, Dias RD, Zenati MA. Importance of high-performing teams in the cardiovascular intensive care unit. J Thorac Cardiovasc Surg 2022; 163:1096-1104. [PMID: 33931232 PMCID: PMC8481338 DOI: 10.1016/j.jtcvs.2021.02.098] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 02/22/2021] [Accepted: 02/23/2021] [Indexed: 12/14/2022]
Affiliation(s)
- Lauren R. Kennedy-Metz
- Department of Surgery, Harvard Medical School, Boston, Mass,Division of Cardiac Surgery, VA Boston Healthcare System, Boston, Mass
| | - Atilio Barbeito
- Anesthesiology Service, Durham VA Health Care System, Durham, NC,Department of Anesthesiology, Duke University, Durham, NC
| | - Roger D. Dias
- Department of Emergency Medicine, Harvard Medical School, Boston, Mass
| | - Marco A. Zenati
- Department of Surgery, Harvard Medical School, Boston, Mass,Division of Cardiac Surgery, VA Boston Healthcare System, Boston, Mass
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Burden A, Potestio C, Pukenas E. Influence of Perioperative Handoffs on Complications and Outcomes. Adv Anesth 2021; 39:133-148. [PMID: 34715971 DOI: 10.1016/j.aan.2021.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Amanda Burden
- Cooper Medical School of Rowan University, Clinical Skills and Simulation Center, 201 South Broadway, #201A, Camden, NJ 08103, USA.
| | - Christopher Potestio
- Department of Anesthesiology, Cooper Medical School of Rowan University, Clinical Skills and Simulation Center, 201 South Broadway, #201A, Camden, NJ 08103, USA
| | - Erin Pukenas
- Department of Anesthesiology, Cooper Medical School of Rowan University, Clinical Skills and Simulation Center, 201 South Broadway, #201A, Camden, NJ 08103, USA
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Redley B, Njambi M, Rawson H. An Examination of Nurses' Empowerment and Speaking Up During Postanesthesia Clinical Hand Overs. AORN J 2021; 113:621-634. [PMID: 34048035 DOI: 10.1002/aorn.13399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 09/22/2020] [Accepted: 11/02/2020] [Indexed: 11/11/2022]
Abstract
Hierarchical relationships can negatively affect nurses' psychological empowerment and interprofessional hand overs. We explored nurses' perceptions of their psychological empowerment, teamwork, and work engagement; relationships between these concepts during interprofessional clinical hand overs; and observed interactive communication behaviors during hand overs. We used surveys and observations of interprofessional clinical hand overs to collect data from 39 nurses in a postanesthesia care unit in Australia. Nurses reported high scores for psychological empowerment and work engagement. Relationships between empowerment and teamwork (r = 0.41, P = .01) and empowerment and work engagement (r = 0.65, P < .001) were positive and significant. Relationships between nurses' observed communication behaviors and perceptions of empowerment, teamwork, and work engagement were nonsignificant. Additional research is needed to better understand how empowerment, teamwork, and work engagement affect nurses' interactive communication behaviors during interprofessional clinical hand overs in the postanesthesia care unit.
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Hong Mershon B, Vannucci A, Bryson T, Lin F, Greilich PE, Dear G, Guffey P, Agarwala A. A Collaborative Partnership between the Multicenter Handoff Collaborative and an Electronic Health Record Vendor. Appl Clin Inform 2021; 12:647-654. [PMID: 34320682 PMCID: PMC8318701 DOI: 10.1055/s-0041-1731714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVES The operating room is a specialized, complex environment with many factors that can impede effective communication during transitions of care between anesthesia clinicians. We postulated that an efficient, accessible, standardized tool for intraoperative handoffs built into standard workflow would improve communication and handoff safety. Most institutions now use an electronic health record (EHR) system for patient care and have independently designed intraoperative handoff tools, but these home-grown tools are not scalable to other organizations and lack vendor-supported features. The goal of this project was to create a standardized, intraoperative handoff tool supported by EHR functionality. METHODS The Multicenter Handoff Collaborative, with support from the Anesthesia Patient Safety Foundation, created a working group of frontline anesthesia experts to collaborate with a development team from the EHR vendor (Epic Systems) to design a standardized intraoperative handoff tool. Over 2 years, the working group identified the critical elements for the tool and software usability, and the EHR team designed a standardized intraoperative handoff tool that is accessible to any institution using this EHR. RESULTS The first iteration of the intraoperative handoff tool was released in August 2019, with a second version in February 2020. The tool is standardized but customizable by individual institutions. CONCLUSION We demonstrate that work on complex health care processes critical to patient safety, such as handoffs, can be performed on a national scale through cross-industry collaboration. Frontline experts can partner with health care industry vendors to design, build, and release a product on an accelerated timeline.
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Affiliation(s)
- Bommy Hong Mershon
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Andrea Vannucci
- Department of Anesthesiology, University of Mississippi Medical Center, Jackson, Mississippi, United States
| | - Trent Bryson
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Felix Lin
- Technical Services, Epic Systems Corporation, Verona, Wisconsin, United States
| | - Philip E Greilich
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Guy Dear
- Department of Anesthesiology and Pediatrics, Duke University, Durham, North Carolina, United States
| | - Patrick Guffey
- Department of Anesthesiology, University of Colorado School of Medicine, Aurora, Colorado, United States
| | - Aalok Agarwala
- Department of Anesthesiology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States
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White LB, Coyne E, Grealish L. Management of delirium within intraoperative settings for older adults with hip fracture: a scoping review. J Clin Nurs 2021; 30:2169-2178. [PMID: 33616299 DOI: 10.1111/jocn.15720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 01/20/2021] [Accepted: 02/12/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Delirium is a common adverse event in older patients undergoing hip fracture repair surgery. The impact of hospital-acquired delirium during intraoperative phase of their treatment can have a significant impact on post-operative outcomes. While non-pharmacological, multicomponent delirium prevention interventions are considered standard practice in acute medical units, delirium management in the intraoperative setting is less clear. OBJECTIVES The aim was to identify evidence-based delirium management interventions which are, and could be, undertaken within the intraoperative setting for older patients undergoing hip fracture repair surgery. DESIGN A scoping review following the principles developed by Arksey and O'Malley (2005). DATA SOURCES Seven databases including Cochrane, CINAHL, Embase, MEDLINE, PsychINFO, PubMed and SCOPUS were systematically searched. The search was limited to the last 11 years (2009-2020). Research studies included both primary and secondary sources of evidence. RESULTS A total of 2464 articles were initially identified. These articles were further refined using keyword searches and exclusion criteria, with a final set of 16 articles meeting the inclusion criteria. Three main themes were as follows: anaesthetic-related interventions used to prevent delirium; recognising non-modifiable and potentially modifiable risk factors; and screening and diagnosis of delirium. CONCLUSIONS While there is a strong focus on anaesthetist-led interventions in the intraoperative setting, there are opportunities for more nurse-led interventions through adequate pain management and haemodynamic monitoring that require further research. Identifying the best test for screening and diagnosing delirium in the intraoperative setting requires further research.
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Affiliation(s)
- Laura Beth White
- School of Nursing & Midwifery & Menzies Health Institute, Griffith University
| | - Elisabeth Coyne
- School of Nursing & Midwifery & Menzies Health Institute, Griffith University
| | - Laurie Grealish
- School of Nursing & Midwifery & Menzies Health Institute, Griffith University.,Gold Coast Health
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13
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Reine E, Aase K, Raeder J, Thorud A, Aarsnes RM, Rustøen T. Exploring postoperative handover quality in relation to patient condition: A mixed methods study. J Clin Nurs 2021; 30:1046-1059. [PMID: 33434381 DOI: 10.1111/jocn.15650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 12/03/2020] [Accepted: 12/31/2020] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES To describe postoperative handover reporting and tasks in relation to patient condition and situational circumstances, in order to identify facilitators for best practices. BACKGROUND High-quality handovers in postoperative settings are important for patient safety and continuity of care. There is a need to explore handover quality in relation to patient condition and other affecting factors. DESIGN Observational mixed methods convergent design. METHODS Postoperative patient handovers were observed collecting quantitative (n = 109) and qualitative data (n = 48). Quantitative data were collected using the postoperative handover assessment tool (PoHAT), and a scoring system assessing patient condition. Qualitative data were collected using free-text field notes and an observational guide. The study adheres to the GRAMMS guideline for reporting mixed methods research. RESULTS Information omissions in the handovers observed ranged from 1-13 (median 7). Handovers of vitally stable and comfortable patients were associated with more information omissions in the report. A total of 50 handovers (46%) were subjected to interruptions, and checklist compliance was low (13%, n = 14). Thematic analysis of the qualitative data identified three themes: "adaptation of handover," "strategies for information transfer" and "contextual and individual factors." Factors facilitating best practices were related to adaptation of the handover to patient condition and situational circumstances, structured verbal reporting, providing patient assessments and dialogue within the handover team. CONCLUSIONS The variations in items reported and tasks performed during the handovers observed were related to patient conditions, situational circumstances and low checklist compliance. Adaptation of the handover to patient condition and situation, structured reporting, dialogue within the team and patient assessments contributed to quality. RELEVANCE TO CLINICAL PRACTICE It is important to acknowledge that handover quality is related to more than transfer of information. The present study has described how factors related to the patient and situation affect handover quality.
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Affiliation(s)
- Elizabeth Reine
- Department of Nurse Anaesthesia, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.,Department of Nursing Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Karina Aase
- SHARE-Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Johan Raeder
- Department of Anaesthesia, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Anne Thorud
- Department of Nurse Anaesthesia, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | - Reidunn M Aarsnes
- Department of Nurse Anaesthesia, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | - Tone Rustøen
- Department of Nursing Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
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Appelbaum R, Martin S, Tinkoff G, Pascual JL, Gandhi RR. Eastern association for the surgery of trauma - quality, patient safety, and outcomes committee - transitions of care: healthcare handoffs in trauma. Am J Surg 2021; 222:521-528. [PMID: 33558061 DOI: 10.1016/j.amjsurg.2021.01.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 01/16/2021] [Accepted: 01/25/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Handoffs are defined as the transfer of patient information, professional responsibility, and accountability between caregivers. This work aims to clarify the current state of transitions of care related to the management of trauma patients. METHODS A PubMed database and web search were performed for articles published between 2000 and 2020 related to handoffs and transitions of care. The key search terms used were: handoff(s), handoff(s) AND healthcare, and handoff(s) AND trauma. A total of 55 studies were included in qualitative synthesis. RESULTS This systematic review explores the current state of healthcare handoffs for trauma patients. Factors found to impact successful handoffs included process standardization, team member accountability, effective communication, and the incorporation of culture. This review was limited by the small number of prospective randomized studies available on the topic. CONCLUSION Handoffs in trauma care have been studied and should be utilized in the context of published experience and practice. Standardization when applied with accountability has proven benefit to reduce communication errors during these transfers of care.
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Affiliation(s)
- Rachel Appelbaum
- Department of Surgery, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA.
| | - Shayn Martin
- Wake Forest School of Medicine, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA.
| | - Glen Tinkoff
- Department of Surgery, University Hospitals, Cleveland, OH, USA.
| | - Jose L Pascual
- Surgery/Neurosurgery, University of Pennsylvania, Philadelphia, PA, USA.
| | - Rajesh R Gandhi
- Department of Surgery, JPS Health Network, Medical Education, TCU/UNTHSC School of Medicine, Fort Worth, TX, USA.
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Hu J, Yang Y, Li X, Yu L, Zhou Y, Fallacaro MD, Wright S. Adverse Outcomes Associated With Intraoperative Anesthesia Handovers: A Systematic Review and Meta-analysis. J Perianesth Nurs 2020; 35:525-532.e1. [DOI: 10.1016/j.jopan.2020.01.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 12/27/2019] [Accepted: 01/09/2020] [Indexed: 12/27/2022]
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Nourallah B, Stubbs DJ, Levy N. Can empathy improve surgical and patient-reported outcomes: benefit to an ‘identifiable patient effectʼ? Br J Anaesth 2020; 124:e225-e226. [DOI: 10.1016/j.bja.2020.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 02/19/2020] [Accepted: 02/20/2020] [Indexed: 10/24/2022] Open
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López-Parra M, Porcar-Andreu L, Arizu-Puigvert M, Pujol-Caballé G. Cohort Study on the Implementation of a Surgical Checklist from the Operating Room to the Postanesthesia Care Unit. J Perianesth Nurs 2020; 35:155-159. [DOI: 10.1016/j.jopan.2019.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 07/31/2019] [Accepted: 08/25/2019] [Indexed: 11/28/2022]
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Communication: Is There a Standard Handover Technique to Transfer Patient Care? Int Anesthesiol Clin 2020; 57:35-47. [PMID: 31577236 DOI: 10.1097/aia.0000000000000241] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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20
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Kim C, Lehmann CU, Hatch D, Schildcrout JS, France DJ, Chen Y. Provider Networks in the Neonatal Intensive Care Unit Associate with Length of Stay. ... IEEE CONFERENCE ON COLLABORATION AND INTERNET COMPUTING. IEEE CONFERENCE ON COLLABORATION AND INTERNET COMPUTING 2019; 2019:127-134. [PMID: 32637942 PMCID: PMC7339831 DOI: 10.1109/cic48465.2019.00024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
We strive to understand care coordination structures of multidisciplinary teams and to evaluate their effect on post-surgical length of stay (PSLOS) in the Neonatal Intensive Care Unit (NICU). Electronic health record (EHR) data were extracted for 18 neonates, who underwent gastrostomy tube placement surgery at the Vanderbilt University Medical Center NICU. Based on providers' interactions with the EHR (e.g. viewing, documenting, ordering), provider-provider relations were learned and used to build patient-specific provider networks representing the care coordination structure. We quantified the networks using standard network analysis metrics (e.g., in-degree, out-degree, betweenness centrality, and closeness centrality). Coordination structure effectiveness was measured as the association between the network metrics and PSLOS, as modeled by a proportional-odds, logistical regression model. The 18 provider networks exhibited various team compositions and various levels of structural complexity. Providers, whose patients had lower PSLOS, tended to disperse patient-related information to more colleagues within their network than those, who treated higher PSLOS patients (P = 0.0294). In the NICU, improved dissemination of information may be linked to reduced PSLOS. EHR data provides an efficient, accessible, and resource-friendly way to study care coordination using network analysis tools. This novel methodology offers an objective way to identify key performance and safety indicators of care coordination and to study dissemination of patient-related information within care provider networks and its effect on care. Findings should guide improvements in the EHR system design to facilitate effective clinical communications among providers.
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Affiliation(s)
- Cindy Kim
- Department of Mathematics, Vanderbilt University, Nashville, TN
| | | | - Dupree Hatch
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | | | - Daniel J France
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN
| | - You Chen
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN
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Croke L. Ensuring effective patient hand overs in the perioperative setting. AORN J 2019; 110:P11-P13. [PMID: 31246308 DOI: 10.1002/aorn.12762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Impact of patient handover structure on neonatal perioperative safety. J Perinatol 2019; 39:453-467. [PMID: 30655594 PMCID: PMC6592629 DOI: 10.1038/s41372-018-0305-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 12/07/2018] [Accepted: 12/13/2018] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To compare the incidence, severity, preventability, and contributing factors of non-routine events-deviations from optimal care based on the clinical situation-associated with team-based, nurse-to-nurse, and mixed handovers in a large cohort of surgical neonates. STUDY DESIGN A prospective observational study and one-time cross-sectional provider survey were conducted at one urban academic children's hospital. 130 non-cardiac surgical cases in 109 neonates who received pre- and post-operative NICU care. RESULTS The incidence of clinician-reported NREs was high (101/130 cases, 78%) but did not differ significantly across acuity-tailored neonatal handover practices. National Surgical Quality Improvement-Pediatric occurrences of major morbidity were significantly higher (p < 0.001) in direct team handovers than indirect nursing or mixed handovers. CONCLUSIONS NREs occur at a high rate and are of variable severity in neonatal perioperative care. NRE rates and contributory factors were homogenous across handover types. Surveyed clinicians recommend structured handovers for all patients at every transfer point regardless of acuity.
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From intensive care unit to operating room: what about the transition of care of liver transplanted patients? Can J Anaesth 2019; 66:613-615. [PMID: 30756341 DOI: 10.1007/s12630-019-01317-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 12/05/2018] [Accepted: 01/14/2019] [Indexed: 10/27/2022] Open
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