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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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Vetter L, Camenzind E. [Patient handover from anaesthesia to postanaesthesia unit: An analysis of the current situation in three Swiss hospitals]. Pflege 2023; 36:87-94. [PMID: 35301868 DOI: 10.1024/1012-5302/a000876] [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] [Indexed: 11/19/2022]
Abstract
Patient handover from anaesthesia to postanaesthesia unit: An analysis of the current situation in three Swiss hospitals Abstract: Background: Patient handovers carry a risk of inadequate or missing communication of important information that can jeopardize patient safety. To increase patient safety, protocols for processes and contents of a structured patient handover were created. Aim: To assess the current status of patient handovers from anaesthesia staff to recovery room nurses. Method: After a literature search an observation protocol for patient handovers according to the SBAR concept (von Dossow & Zwißler, 2016) was developed. Using this checklist, non-participant observations were conducted in three Swiss hospitals and evaluated with statistical analysis. Results: A total of 98 observations were made. The report receiving person felt integrated into the handover and received the necessary information. Deficiencies in patient identification and a joint control of lines after surgical interventions could be identified. The subjectively rated quality of patient handover did not differ between the three hospitals (X2(2)=,927, p=,629) and also not according to the time of day (X2(2)=3,604, p=,216). There was also no difference between the subjective quality of the handover and the delivering professional group (X2(3)=4,507, p=,212). Conclusions: The subjective quality of patient handover did not differ between the three hospitals. However, the patient handover protocols need to be adapted to ensure that patient identification and a joint assessment including control of lines and drains are performed.
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Affiliation(s)
- Luzia Vetter
- Klinik für Anästhesie, Luzerner Kantonsspital, Luzern, Schweiz
| | - Elena Camenzind
- Universitätsklinik für Anästhesiologie und Schmerztherapie, Inselspital, Bern, Schweiz
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Bell E, Benefield D, Vollenweider A, Wilson K, Warren LL, Aroke EN. Improving Communication Between ICU Nurses and Anesthesia Providers Using a Standardized Handoff Protocol. J Perianesth Nurs 2023; 38:200-205. [PMID: 36241539 DOI: 10.1016/j.jopan.2022.08.002] [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: 03/16/2022] [Revised: 08/04/2022] [Accepted: 08/10/2022] [Indexed: 11/05/2022]
Abstract
PURPOSE This quality improvement (QI) project aimed to improve handoff communication between intensive care unit (ICU) nurses and anesthesia providers using a standardized preoperative handoff protocol for nonemergent and noncardiac procedures. DESIGN A quality improvement project. METHODS Following project approval, the project team provided staff education regarding a pre-populated handoff tool from the electronic medical record (EMR) adapted for perioperative use. In addition, the project team assessed the providers' perception and satisfaction with handoff communication before and after the intervention. FINDINGS Of the 128 transfers, 76% completed the handoff tool during the 1-month implementation phase. CRNAs (n = 60), Registered Nurses (RNs; n = 88), and anesthesia residents (n = 30) completed the pre-and post-implementation surveys. Pre-implementation, 40% of providers were dissatisfied with communication, and only 14% reported dissatisfaction post-implementation. Also, 40% of providers believed this handoff protocol increased the amount of accurate information shared during reports without delaying the transition of care. CONCLUSIONS The standardized handoff tool appears to improve information sharing during the transfer of care and improve provider satisfaction with the handoff process. Long term, it may reduce adverse patient events and improve outcomes. Use of a pre-populated handoff tool from the EMR provides a cost-effective solution to decrease erroneous reporting by removing human error associated with the recall.
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Affiliation(s)
- Erica Bell
- University of Alabama at Birmingham School of Nursing in Birmingham, AL
| | - Daniel Benefield
- University of Alabama at Birmingham School of Nursing in Birmingham, AL.
| | | | - Karissa Wilson
- University of Alabama at Birmingham School of Nursing in Birmingham, AL
| | - Laqueatrece Lashon Warren
- Nurse Anesthesia Program at the University of Alabama at Birmingham School of Nursing in Birmingham, AL
| | - Edwin N Aroke
- Nurse Anesthesia Program at the University of Alabama at Birmingham School of Nursing in Birmingham, AL
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Lazzara EH, Simonson RJ, Gisick LM, Griggs AC, Rickel EA, Wahr J, Lane-Fall MB, Keebler JR. Does standardisation improve post-operative anaesthesia handoffs? Meta-analyses on provider, patient, organisational, and handoff outcomes. ERGONOMICS 2022; 65:1138-1153. [PMID: 35438045 DOI: 10.1080/00140139.2021.2020341] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 12/12/2021] [Indexed: 06/14/2023]
Abstract
Anaesthesia handoffs are associated with negative outcomes (e.g. inappropriate treatments, post-operative complications, and in-hospital mortality). To minimise these adverse outcomes, federal bodies (e.g. Joint Commission) have mandated handoff standardisation. Due to the proliferation of handoff interventions and research, there is a need to meta-analyze anaesthesia handoffs. Therefore, we performed meta-analyses on the provider, patient, organisational, and handoff outcomes related to post-operative anaesthesia handoff protocols. We meta-analysed 41 articles with post-operative anaesthesia handoffs that implemented a standardised handoff protocol. Compared to no standardisation, a standardised post-operative anaesthesia handoff changed provider outcomes with an OR of 4.03 (95% CI 3.20-5.08), patient outcomes with an OR of 1.49 (95% CI 1.32-1.69), organisational outcomes with an OR of 4.25 (95% CI 2.51-7.19), handoff outcomes with an OR of 8.52 (95% CI 7.05-10.31). Our meta-analyses demonstrate that standardised post-operative anaesthesia handoffs altered patient, provider, organisational, and handoff outcomes. Practitioner Summary: We conducted meta-analyses to assess the effects of post-operative anaesthesia handoff standardisation on provider, patient, organisational, and handoff outcomes. Our findings suggest that standardised post-operative anaesthesia handoffs changed all listed outcomes in a positive direction. We discuss the implications of these findings as well as notable limitations in this literature base.
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Affiliation(s)
- Elizabeth H Lazzara
- Department of Human Factors and Behavioral Neurobiology, Embry-Riddle Aeronautical University, Daytona Beach, FL, USA
| | - Richard J Simonson
- Department of Human Factors and Behavioral Neurobiology, Embry-Riddle Aeronautical University, Daytona Beach, FL, USA
| | - Logan M Gisick
- Department of Human Factors and Behavioral Neurobiology, Embry-Riddle Aeronautical University, Daytona Beach, FL, USA
| | - Andrew C Griggs
- Department of Human Factors and Behavioral Neurobiology, Embry-Riddle Aeronautical University, Daytona Beach, FL, USA
| | - Emily A Rickel
- Department of Human Factors and Behavioral Neurobiology, Embry-Riddle Aeronautical University, Daytona Beach, FL, USA
| | - Joyce Wahr
- Department of Anesthesiology, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Meghan B Lane-Fall
- David E. Longnecker Associate Professor of Anesthesiology and Critical Care, Department of Anesthesiology and Critical Care, Perelman School of Medicine University of Pennsylvania, Philadelphia, PA, USA
| | - Joseph R Keebler
- Department of Human Factors and Behavioral Neurobiology, Embry-Riddle Aeronautical University, Daytona Beach, FL, USA
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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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Nonoperating room anesthesia: strategies to improve performance. Int Anesthesiol Clin 2021; 59:27-36. [PMID: 34456276 DOI: 10.1097/aia.0000000000000339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Jelacic S, Togashi K, Bussey L, Nair BG, Wu T, Boorman DJ, Bowdle A. Development of an aviation-style computerized checklist displayed on a tablet computer for improving handoff communication in the post-anesthesia care unit. J Clin Monit Comput 2020; 35:607-616. [PMID: 32405801 DOI: 10.1007/s10877-020-00521-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 05/05/2020] [Indexed: 10/24/2022]
Abstract
Critical patient care information is often omitted or misunderstood during handoffs, which can lead to inefficiencies, delays, and sometimes patient harm. We implemented an aviation-style post-anesthesia care unit (PACU) handoff checklist displayed on a tablet computer to improve PACU handoff communication. We developed an aviation-style computerized checklist system for use in procedural rooms and adapted it for tablet computers to facilitate the performance of PACU handoffs. We then compared the proportion of PACU handoff items communicated before and after the implementation of the PACU handoff checklist on a tablet computer. A trained observer recorded the proportion of PACU handoff information items communicated, any resistance during the performance of the checklist, the type of provider participating in the handoff, and the time required to perform the handoff. We also obtained these patient outcomes: PACU length of stay, respiratory events, post-operative nausea and vomiting, and pain. A total of 209 PACU handoffs were observed before and 210 after the implementation of the tablet-based PACU handoff checklist. The average proportion of PACU handoff items communicated increased from 49.3% (95% CI 47.7-51.0%) before checklist implementation to 72.0% (95% CI 69.2-74.9%) after checklist implementation (p < 0.001). A tablet-based aviation-style handoff checklist resulted in an increase in PACU handoff items communicated, but did not have an effect on patient outcomes.
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Affiliation(s)
- Srdjan Jelacic
- Department of Anesthesiology and Pain Medicine, University of Washington, 1959 NE Pacific Street, AA-117B, Box 356540, Seattle, WA, 98195-6540, USA.
| | - Kei Togashi
- Department of Anesthesiology and Pain Medicine, University of Washington, 1959 NE Pacific Street, AA-117B, Box 356540, Seattle, WA, 98195-6540, USA
| | - Logan Bussey
- Department of Anesthesiology and Pain Medicine, University of Washington, 1959 NE Pacific Street, AA-117B, Box 356540, Seattle, WA, 98195-6540, USA
| | - Bala G Nair
- Department of Anesthesiology and Pain Medicine, University of Washington, 1959 NE Pacific Street, AA-117B, Box 356540, Seattle, WA, 98195-6540, USA
| | - Tim Wu
- Department of Anesthesiology and Pain Medicine, University of Washington, 1959 NE Pacific Street, AA-117B, Box 356540, Seattle, WA, 98195-6540, USA
| | - Daniel J Boorman
- The Boeing Company, Boeing Test and Evaluation, Seattle, WA, USA
| | - Andrew Bowdle
- Department of Anesthesiology and Pain Medicine, University of Washington, 1959 NE Pacific Street, AA-117B, Box 356540, Seattle, WA, 98195-6540, USA
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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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