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Trotta RL, Shoemaker AE, Greysen SR, Boltz M. Pilot Process Evaluation of the Supporting Older Adults at Risk Model: A RE-AIM Approach. J Healthc Qual 2024; 46:e26-e39. [PMID: 38743004 DOI: 10.1097/jhq.0000000000000435] [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: 05/16/2024]
Abstract
ABSTRACT Despite evidence supporting transitional care models, hospitals report challenges implementing and sustaining them. The Discharge to Assess (D2A) Model is an innovative solution to this problem but required translation from a national health system context to an U.S.-based context. We translated the central tenets of the D2A model to establish the Supporting Older Adults at Risk (SOAR) Model, which unfolds in three phases: Prepare, Transition, and Support. The purpose of this project was to conduct a process evaluation of the SOAR Model in practice using the RE-AIM Framework (Reach, Effectiveness, Adoption, Implementation, and Maintenance). Forty patients completed all SOAR Model components for a Reach of 21%. Patients averaged 80 years of age, 53% were female, and 64% Black/AA. SOAR significantly improved discharge before noon, time to first home visit, and use of the in-house pharmacy. SOAR also improved length of hospital stay, emergency department visits, and readmissions. Twenty-one of the 26 Implementation measures unfolded with 75% or greater fidelity. Sixteen of the 24 Adoption measures unfolded with 75% or greater fidelity. COVID-19 limited Maintenance. Given the model unfolds across settings over time, requiring adoption from interprofessional team members, patients, and families, future work should focus on improving reach and adoption.
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Reifarth E, Naendrup JH, Garcia Borrega J, Altenrath L, Shimabukuro-Vornhagen A, Eichenauer DA, Kochanek M, Böll B. [Handoffs in the intensive care unit]. Med Klin Intensivmed Notfmed 2024; 119:253-259. [PMID: 38498181 DOI: 10.1007/s00063-024-01127-x] [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: 11/21/2023] [Accepted: 02/09/2024] [Indexed: 03/20/2024]
Abstract
BACKGROUND Effective handoffs in the intensive care unit (ICU) are key to patient safety. PURPOSE This article aims to raise awareness of the significance of structured and thorough handoffs and highlights possible challenges as well as means for improvement. MATERIALS AND METHODS Based on the available literature, the evidence regarding handoffs in ICUs is summarized and suggestions for practical implementation are derived. RESULTS The quality of handoffs has an impact on patient safety. At the same time, communication in the intensive care setting is particularly challenging due to the complexity of cases, a disruptive work environment, and a multitude of inter- and intraprofessional interactions. Hierarchical team structures, deficiencies in feedback and error-management culture, (technical) language barriers in communication, as well as substantial physical and psychological stress may negatively influence the effectiveness of handoffs. Sets of interventions such as the implementation of checklists, mnemonics, and communication workshops contribute to a more structured and thorough handoff process and have the potential to significantly improve patient safety. CONCLUSION Effective handoffs are the cornerstone of high-quality and safe patient care but face particular challenges in ICUs. Interventional measures such as structuring handoff concepts and periodic communication trainings can help to improve handoffs and thus increase patient safety.
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Affiliation(s)
- Eyleen Reifarth
- Klinik I für Innere Medizin, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
| | - Jan-Hendrik Naendrup
- Klinik I für Innere Medizin, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - Jorge Garcia Borrega
- Klinik I für Innere Medizin, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - Lisa Altenrath
- Klinik I für Innere Medizin, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | | | | | - Matthias Kochanek
- Klinik I für Innere Medizin, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - Boris Böll
- Klinik I für Innere Medizin, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland
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Bass GA, Kaplan LJ, Gaarder C, Coimbra R, Klingensmith NJ, Kurihara H, Zago M, Cioffi SPB, Mohseni S, Sugrue M, Tolonen M, Valcarcel CR, Tilsed J, Hildebrand F, Marzi I. European society for trauma and emergency surgery member-identified research priorities in emergency surgery: a roadmap for future clinical research opportunities. Eur J Trauma Emerg Surg 2024; 50:367-382. [PMID: 38411700 PMCID: PMC11035411 DOI: 10.1007/s00068-023-02441-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 12/28/2023] [Indexed: 02/28/2024]
Abstract
BACKGROUND European Society for Trauma and Emergency Surgery (ESTES) is the European community of clinicians providing care to the injured and critically ill surgical patient. ESTES has several interlinked missions - (1) the promotion of optimal emergency surgical care through networked advocacy, (2) promulgation of relevant clinical cognitive and technical skills, and (3) the advancement of scientific inquiry that closes knowledge gaps, iteratively improves upon surgical and perioperative practice, and guides decision-making rooted in scientific evidence. Faced with multitudinous opportunities for clinical research, ESTES undertook an exercise to determine member priorities for surgical research in the short-to-medium term; these research priorities were presented to a panel of experts to inform a 'road map' narrative review which anchored these research priorities in the contemporary surgical literature. METHODS Individual ESTES members in active emergency surgery practice were polled as a representative sample of end-users and were asked to rank potential areas of future research according to their personal perceptions of priority. Using the modified eDelphi method, an invited panel of ESTES-associated experts in academic emergency surgery then crafted a narrative review highlighting potential research priorities for the Society. RESULTS Seventy-two responding ESTES members from 23 countries provided feedback to guide the modified eDelphi expert consensus narrative review. Experts then crafted evidence-based mini-reviews highlighting knowledge gaps and areas of interest for future clinical research in emergency surgery: timing of surgery, inter-hospital transfer, diagnostic imaging in emergency surgery, the role of minimally-invasive surgical techniques and Enhanced Recovery After Surgery (ERAS) protocols, patient-reported outcome measures, risk-stratification methods, disparities in access to care, geriatric outcomes, data registry and snapshot audit evaluations, emerging technologies interrogation, and the delivery and benchmarking of emergency surgical training. CONCLUSIONS This manuscript presents the priorities for future clinical research in academic emergency surgery as determined by a sample of the membership of ESTES. While the precise basis for prioritization was not evident, it may be anchored in disease prevalence, controversy around aspects of current patient care, or indeed the identification of a knowledge gap. These expert-crafted evidence-based mini-reviews provide useful insights that may guide the direction of future academic emergency surgery research efforts.
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Affiliation(s)
- Gary Alan Bass
- Division of Traumatology, Emergency Surgery and Surgical Critical Care, Perelman School of Medicine, University of Pennsylvania, 51 N. 39th Street, MOB 1, Suite 120, Philadelphia, PA, 19104, USA.
- Leonard Davis Institute of Health Economics (LDI), University of Pennsylvania, Philadelphia, PA, USA.
- Center for Perioperative Outcomes Research and Transformation (CPORT), University of Pennsylvania, Philadelphia, PA, USA.
| | - Lewis Jay Kaplan
- Division of Traumatology, Emergency Surgery and Surgical Critical Care, Perelman School of Medicine, University of Pennsylvania, 51 N. 39th Street, MOB 1, Suite 120, Philadelphia, PA, 19104, USA
- Surgical Critical Care, Corporal Michael J Crescenz VA Medical Center, 3900 Woodland Avenue, Philadelphia, PA, 19104, USA
| | - Christine Gaarder
- Department of Traumatology at Oslo University Hospital Ullevål (OUH U), Olso, Norway
| | - Raul Coimbra
- Riverside University Health System Medical Center, Moreno Valley, CA, USA
- Loma Linda University School of Medicine, Loma Linda, CA, USA
- Comparative Effectiveness and Clinical Outcomes Research Center - CECORC, Moreno Valley, CA, USA
| | - Nathan John Klingensmith
- Division of Traumatology, Emergency Surgery and Surgical Critical Care, Perelman School of Medicine, University of Pennsylvania, 51 N. 39th Street, MOB 1, Suite 120, Philadelphia, PA, 19104, USA
| | - Hayato Kurihara
- State University of Milan, Milan, Italy
- Emergency Surgery Unit, Ospedale Policlinico di Milano, Milan, Italy
| | - Mauro Zago
- General & Emergency Surgery Division, A. Manzoni Hospital, ASST, Lecco, Lombardy, Italy
| | | | - Shahin Mohseni
- Department of Surgery, Sheikh Shakhbout Medical City (SSMC), Abu Dhabi, United Arab Emirates
- Division of Trauma and Emergency Surgery, Department of Surgery, Orebro University Hospital, 701 85, Orebro, Sweden
- Faculty of School of Medical Sciences, Orebro University, 702 81, Orebro, Sweden
| | - Michael Sugrue
- Letterkenny Hospital and Galway University, Letterkenny, Ireland
| | - Matti Tolonen
- Emergency Surgery, Meilahti Tower Hospital, HUS Helsinki University Hospital, Haartmaninkatu 4, PO Box 340, 00029, Helsinki, HUS, Finland
| | | | - Jonathan Tilsed
- Hull Royal Infirmary, Anlaby Road, Hu3 2Jz, Hull, England, UK
| | - Frank Hildebrand
- Department of Orthopaedics Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Ingo Marzi
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt, Frankfurt, Germany
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Qian X, Lui KY, Li S, Song X, Xu J, Dou R, Luo G, Li L, Cai C. Structured postoperative handover protocol improves efficiency and quality of interdisciplinary communication and nursing care in surgical intensive care unit: a randomized controlled trial. Updates Surg 2024; 76:289-298. [PMID: 37277673 DOI: 10.1007/s13304-023-01551-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 05/26/2023] [Indexed: 06/07/2023]
Abstract
This study aimed to evaluate the effectiveness of a structured postoperative handover protocol for postoperative transfer to the SICU. This study was a randomized controlled trial conducted in a comprehensive teaching hospital in China. Patients who were transferred to the SICU after surgery were randomly divided into two groups. The intervention group underwent postoperative structured handover protocol, and the control group still applied conventional oral handover. A total of 101 postoperative patients and 50 clinicians were enrolled. Although the intervention group did not shorten the handover duration (6.18 ± 1.66 vs 5.94 ± 1.91; P = 0.505), the handover integrity was significantly improved, mainly reflected in fewer information omissions (1.44 ± 0.97 vs 0.67 ± 0.62; P < 0.001), fewer additional questions raised by ICU physicians (1.06 ± 1.04 vs 0.24 ± 0.43; P < 0.001) and fewer additional handovers via phone call (16% vs 3.9%; P = 0.042). The total score of satisfaction of the intervention group was significantly higher than that of the control group (76.44 ± 7.32 vs 81.24 ± 6.95; P = 0.001). With respect to critical care, the incidence of stage I pressure sore within 24 h was lower in the intervention group than in the control group (20% vs 3.9%, P = 0.029). Structured postoperative handover protocol improves the efficiency and quality of interdisciplinary communication and clinical care in SICU.Trial registration This study was registered in China on January 8th, 2022 at Chinese Clinical Trial Registry (ChiCTR2200055400).
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Affiliation(s)
- Xiayan Qian
- Department of Critical Care Medicine, The First Affiliated Hospital of Sun Yat-Sen University, No.58, Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080, Guangdong Province, China
| | - Ka Yin Lui
- Department of Critical Care Medicine, The First Affiliated Hospital of Sun Yat-Sen University, No.58, Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080, Guangdong Province, China
| | - Shuhe Li
- Department of Critical Care Medicine, The First Affiliated Hospital of Sun Yat-Sen University, No.58, Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080, Guangdong Province, China
| | - Xiaodong Song
- Department of Critical Care Medicine, The First Affiliated Hospital of Sun Yat-Sen University, No.58, Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080, Guangdong Province, China
| | - Jinghong Xu
- Department of Anesthesiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Ruoxu Dou
- Department of Critical Care Medicine, The First Affiliated Hospital of Sun Yat-Sen University, No.58, Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080, Guangdong Province, China
| | - Gen Luo
- Department of Critical Care Medicine, The First Affiliated Hospital of Sun Yat-Sen University, No.58, Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080, Guangdong Province, China
| | - Liqiong Li
- Department of Nursing, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Changjie Cai
- Department of Critical Care Medicine, The First Affiliated Hospital of Sun Yat-Sen University, No.58, Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080, Guangdong Province, China.
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Persaud E, Nissley C, Piasecki E, Quinn C. Transition of Care for Older Adults Undergoing General Surgery. Crit Care Nurs Clin North Am 2023; 35:453-467. [PMID: 37838418 DOI: 10.1016/j.cnc.2023.05.009] [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: 10/16/2023]
Abstract
The demand for surgical intervention and hospitalization is expected to increase with the growth of the older adult population. Despite advances in technology and minimally invasive surgical procedures, the needs of the older adult in the perioperative period are unique. Transitions of care from the decision to support surgery through surgical intervention, subsequent hospitalization, and postacute discharge must be supported to achieve optimal patient outcomes. The clinical nurse specialist is well suited to address care delivery and assure implementation of best practices across the continuum.
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Affiliation(s)
- Elissa Persaud
- Michigan Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5866, USA.
| | - Courtney Nissley
- Penn Medicine Lancaster General Hospital, 555 North Duke Street, Lancaster, PA 17602, USA
| | - Eric Piasecki
- Penn Medicine Lancaster General Hospital, 555 North Duke Street, Lancaster, PA 17602, USA
| | - Carrie Quinn
- Penn Medicine Lancaster General Hospital, 555 North Duke Street, Lancaster, PA 17602, USA
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Alcalá Minagorre PJ, Domingo Garau A, Salmerón Fernández MJ, Casado Reina C, Díaz Pernas P, Hernández Borges ÁA, Rodríguez Marrodán B. Safe handoff practices and improvement of communication in different paediatric settings. An Pediatr (Barc) 2023; 99:185-194. [PMID: 37640658 DOI: 10.1016/j.anpede.2023.08.008] [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: 05/21/2023] [Revised: 06/22/2023] [Accepted: 07/03/2023] [Indexed: 08/31/2023] Open
Abstract
Inadequate information management, especially during patient handoff, contributes to a large part of health care-related adverse events. The Committee for Quality of Care and Patient Safety of the Asociación Española de Pediatría has developed this document to provide an overview of handover practices in different paediatric care settings (emergency, inpatient, intensive care, neonatal and primary care). It describes resources to achieve safe and effective communication in all these settings, such as standardised handoff tools. It also proposes recommendations for the prevention of medication errors during the handover process, to improve safety in interhospital and intrahospital patient transfer, and to optimise communication and continuity of care in chronically ill and medically complex children.
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Affiliation(s)
- Pedro J Alcalá Minagorre
- Unidad de Pediatría Interna Hospitalaria, Hospital General Universitario Dr Balmis, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain.
| | - Araceli Domingo Garau
- Servicio de Urgencias de Pediatría, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | | | - Cristina Casado Reina
- Unidad de Farmacia de Atención Primaria, Dirección Asistencial Norte de la Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain
| | - Pilar Díaz Pernas
- Centro de Salud Rosa Luxemburgo, San Sebastián de los Reyes, Madrid, Spain
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Abraham J, Rosen M, Greilich PE. Improving Perioperative Handoffs: Moving Beyond Standardized Checklists and Protocols. Jt Comm J Qual Patient Saf 2023; 49:341-344. [PMID: 37353400 PMCID: PMC10754391 DOI: 10.1016/j.jcjq.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2023]
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Lane-Fall MB, Koilor CB, Givan K, Klaiman T, Barg FK. Patient- and Team-Level Characteristics Associated with Handoff Protocol Fidelity in a Hybrid Implementation Study: Results from a Qualitative Comparative Analysis. Jt Comm J Qual Patient Saf 2023; 49:356-364. [PMID: 37208240 PMCID: PMC10524533 DOI: 10.1016/j.jcjq.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 04/14/2023] [Accepted: 04/17/2023] [Indexed: 05/21/2023]
Abstract
BACKGROUND Standardization is an evidence-based approach to improve handoffs. The factors underpinning fidelity (that is, adherence) to standardized handoff protocols are not well specified, which hampers implementation and sustainability efforts. METHODS The Handoffs and Transitions in Critical Care (HATRICC) study (2014-2017) involved the creation and implementation of a standardized protocol for operating room (OR)-to-ICU handoffs in two mixed surgical ICUs. The present study used fuzzy-set qualitative comparative analysis (fsQCA) to characterize combinations of conditions associated with fidelity to the HATRICC protocol. Conditions were derived from postintervention handoff observations yielding quantitative and qualitative data. RESULTS Sixty handoffs had complete fidelity data. Four conditions from the SEIPS 2.0 model were used to explain fidelity: (1) whether the patient was newly admitted to the ICU; (2) presence of an ICU provider; (3) observer ratings of attention-paying by the handoff team; and (4) whether the handoff took place in a quiet environment. None of the conditions were singly necessary or sufficient for high fidelity. Three combinations of conditions were sufficient for fidelity: (1) presence of the ICU provider and high attention ratings; (2) a newly admitted patient, presence of the ICU provider, and quiet environment; and (3) a newly admitted patient, high attention ratings, and quiet environment. These three combinations explained 93.5% of the cases demonstrating high fidelity. CONCLUSION In a study of OR-to-ICU handoff standardization, multiple combinations of contextual factors were associated with handoff protocol fidelity. Handoff implementation efforts should consider multiple fidelity-promoting strategies that support these combinations of conditions.
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Keebler JR, Lynch I, Ngo F, Phelps E, Huang N, Guttman O, Preble R, Minhajuddin AT, Gamez N, Wanat-Hawthorne A, Landgraf K, Minnis E, Gisick L, McBroom M, Ambardekar A, Olson D, Greilich PE. Leveraging the Science of Teamwork to Sustain Handoff Improvements in Cardiovascular Surgery. Jt Comm J Qual Patient Saf 2023:S1553-7250(23)00120-4. [PMID: 37357132 DOI: 10.1016/j.jcjq.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 05/23/2023] [Accepted: 05/24/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND Improving the reliability of handoffs and care transitions is an important goal for many health care organizations. Increasing evidence shows that human-centered design and improved teamwork can lead to sustainable care transition improvements and better patient outcomes. This study was conducted within a cardiovascular service line at an academic medical center that performs more than 600 surgical procedures annually. A handoff process previously implemented at the center was poorly adopted. This work aimed to improve cardiovascular handoffs by applying human factors and the science of teamwork. METHODS The study's quality improvement method used Plan-Do-Study-Act cycles and participatory design and ergonomics to develop, implement, and assess a new handoff process and bundle. Trained observers analyzed video-recorded and live handoffs to assess teamwork, leadership, communication, coordination, cooperation, and sustainability of unit-defined handoff best practices. The intervention included a teamwork-focused redesign process and handoff bundle with supporting cognitive aids and assessment metrics. RESULTS The study assessed 153 handoffs in multiple phases over 3 years (2016-2019). Quantitative and qualitative assessments of clinician (teamwork) and implementation outcomes were performed. Compared with the baseline, the observed handoffs demonstrated improved team leadership (p < 0.0001), communication (p < 0.0001), coordination (p = 0.0018), and cooperation (p = 0.007) following the deployment of the handoff bundle. Sustained improvements in fidelity to unit-defined handoff best practices continued 2.3 years post-deployment of the handoff bundle. CONCLUSION Participatory design and ergonomics, combined with implementation and safety science principles, can provide an evidence-based approach for sustaining complex sociotechnical change and making handoffs more reliable.
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Rojas-Ocaña MJ, Teresa-Morales C, Ramos-Pichardo JD, Araujo-Hernández M. Barriers and Facilitators of Communication in the Medication Reconciliation Process during Hospital Discharge: Primary Healthcare Professionals' Perspectives. Healthcare (Basel) 2023; 11:healthcare11101495. [PMID: 37239781 DOI: 10.3390/healthcare11101495] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 05/01/2023] [Accepted: 05/18/2023] [Indexed: 05/28/2023] Open
Abstract
The WHO established that medication errors are the most common and preventable errors and represent an expenditure of 42 billion U.S. dollars annually. The risk of medication errors increases in transitions between levels of care, mainly from hospital care to primary healthcare after hospital discharge. In this context, communication is a key element in the safety of the medication reconciliation process. The aim of this paper was to describe the barriers to, and facilitators of, effective communication during the medication reconciliation process at hospital discharge in people over 65 years of age, from the perspective of primary healthcare professionals. A qualitative descriptive study was designed, and in-depth interviews were conducted with 21 individuals, of whom 13 were nurses and 8 were physicians. This study was carried out with healthcare professionals belonging to primary healthcare centres in Huelva (Spain). Following content analysis of the discourses we identified 19 categories, grouped into three areas: interlevel communication, communication between primary healthcare professionals, and communication between healthcare professionals and patients/caregivers. The barriers found mainly relate to the adequacy and use of technological tools, time available, workload and the level of collaboration of patients/caregivers. Facilitating elements for communication in medication reconciliation included technologies, such as computerized medical history, protocolization of clinical sessions, the presence of case management nurse and interdisciplinary teamwork.
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Conn Busch J, Wu J, Anglade E, Peifer HG, Lane-Fall MB. So Many Ways to Be Wrong: Completeness and Accuracy in a Prospective Study of OR-to-ICU Handoff Standardization. Jt Comm J Qual Patient Saf 2023:S1553-7250(23)00115-0. [PMID: 37316396 DOI: 10.1016/j.jcjq.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 04/30/2023] [Accepted: 05/09/2023] [Indexed: 06/16/2023]
Abstract
BACKGROUND Studies focused on improving handoffs often measure the quality of information exchange using information completeness without reporting on accuracy. The present investigation aimed to characterize changes in the accuracy of transmitted patient information after standardization of operating room (OR)-to-ICU handoffs. METHODS Handoffs and Transitions in Critical Care (HATRICC) was a mixed methods study conducted in two US ICUs. From 2014 to 2016, trained observers captured the nature and content of information transmitted during OR-to-ICU handoffs, comparing this to the electronic medical record. Inconsistencies were compared before and after handoff standardization. Semistructured interviews initially conducted for implementation were reanalyzed to contextualize quantitative findings. RESULTS A total of 160 OR-to-ICU handoffs were observed-63 before and 97 after standardization. Across seven categories of information, including allergies, past surgical history, and IV fluids, two types of inaccuracy were observed: incomplete information (for example, providing only a partial list of allergies) and incorrect information. Before standardization, an average of 3.5 information elements per handoff were incomplete, and 0.11 were incorrect. After standardization, the number of incomplete information elements per handoff decreased to 2.4 (-1.1, p < 0.001), and the number of incorrect items was similar, at 0.16 (p = 0.54). Interviews revealed that the familiarity of a transporting OR provider (for example, surgeon, anesthetist) with the patient's case was considered an important factor affecting information exchange. CONCLUSION Handoff accuracy improved after standardizing OR-to-ICU handoffs in a two-ICU study. The improvement in accuracy was due to improved completeness rather than a change in the transmission of inaccurate information.
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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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Kamdar BB, Zee H, Preiss D, Navedo DD, Minehart RD. Perceptions and goals of preoperative planning conversations between anesthesiology residents and attending physicians. J Clin Anesth 2023; 87:111086. [PMID: 36871486 DOI: 10.1016/j.jclinane.2023.111086] [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: 09/22/2022] [Revised: 02/09/2023] [Accepted: 02/19/2023] [Indexed: 03/06/2023]
Abstract
STUDY OBJECTIVE To systematically evaluate anesthesiology resident and attending perceptions of preoperative planning conversations (POPCs) and to generate understanding for improving the educational and clinical value of this practice. DESIGN cross-sectional study. SETTING two large Northeastern US academic residency training programs. PARTICIPANTS clinically practicing anesthesiology residents and attendings. INTERVENTIONS An electronic survey was administered to 303 anesthesia attendings and 168 anesthesia residents across two academic institutions between June and July 2014. MEASUREMENTS Survey questions addressing phone call frequency and duration, clinical value, educational value and intended purpose of POPC were administered to both groups. Chi-squared tests were used to evaluate differences in responses between groups, with p < 0.05 as statistically significant. MAIN RESULTS Responses were collected from 93 attending physicians (31%) and 80 trainee physicians (48%) for an overall response rate of 37%. 99% of residents reported paging their attendings to engage in the POPC the evening prior to all operations and 95% of trainees reported almost always receiving a call back from the attending. Trainees overwhelmingly reported attendings would believe they were unprofessional or negligent if they did not initiate a POPC (73% vs 14%, chi-square = 60.9, p < 0.001). Attendings were much more likely to view the POPC as a very important tool to discuss perioperative events (60% vs 16%, chi-square = 37.3, p < 0.001) and necessary for the majority or every case (59% vs. 31%, chi-square = 13.5, p < 0.001). The majority of attendings and trainees did not find the POPC to be a very important educational tool in terms of assessing trainee knowledge base (14% vs. 6%, chi-square = 2.76, p = 0.097), discussing teaching opportunities (26% vs. 9%, chi-square = 8.5, p = 0.004), or establishing rapport (24% vs. 7% trainees, chi-square = 8.3, p = 0.004). CONCLUSIONS Significant discrepancies exist between how anesthesia attendings and residents perceive the purpose of the POPC, with trainees less likely to view the POPC as having clinical value and neither group perceiving the conversation as a very useful educational tool. The results highlight the need to reexamine the value of the daily POPC as a deliberate educational practice to meet expectations of both trainees and attendings.
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Affiliation(s)
- Brinda B Kamdar
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
| | - Howard Zee
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - David Preiss
- Harvard Medical School, Boston, MA, USA; Department of Anesthesia, Brigham & Women's Hospital, Boston, MA, USA
| | - Deborah D Navedo
- STRATUS Center for Medical Simulation, Brigham & Women's Hospital, Boston, MA, USA
| | - Rebecca D Minehart
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Center for Medical Simulation, Charlestown, MA, USA
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14
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Riesenberg LA, Davis R, Heng A, Vong do Rosario C, O'Hagan EC, Lane-Fall M. Anesthesiology Patient Handoff Education Interventions: A Systematic Review. Jt Comm J Qual Patient Saf 2022:S1553-7250(22)00296-3. [PMID: 36631352 DOI: 10.1016/j.jcjq.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 12/07/2022] [Accepted: 12/08/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND Anesthesiology provider handoffs are complex, occur frequently, and have been associated with adverse patient outcomes. The authors sought to determine the degree to which anesthesiology handoff studies with educational interventions incorporated tenets of educational best practices. METHODS The research team conducted a systematic review of the peer-reviewed literature focused on handoff studies with education interventions that included anesthesiology providers. Searches were conducted using PubMed, Embase, Scopus, Cochrane, and ERIC (2010-September 2021). Each phase of the article review process included at least two trained independent reviewers. In addition, pairs of trained reviewers abstracted study characteristics RESULTS: Twenty-six articles met inclusion criteria. Two thirds (18/26; 69.2%) were published after 2017, and almost three fourths (19/26; 73.1%) included learners. Education intervention descriptions varied, with only 15.4% (4/26) briefly mentioning education theory, 7.7% (2/26) with clear education objectives, and 7.7% (2/26) assessing curriculum via participant satisfaction. Most (22/26; 84.6%) assessed Kirkpatrick's level 3 (handoff behavior change), and 26.9% (7/26) assessed level 4b (patient outcomes). Medical education quality scores were low (range 6-24, mean 11.3; max 32), with more than half (15/26; 57.7%) receiving scores ≤ 10. CONCLUSION Educational interventions demonstrate marked heterogeneity in the use of educational theoretical concepts and established curriculum development best practices. Future studies should report on important aspects of educational interventions, which would allow for comparison across studies, yield the essential data needed to identify handoff education best practices, and improve patient safety.
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15
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Daly Guris RJ, Lane-Fall MB. Checklists and cognitive aids: underutilized and under-researched tools to promote patient safety and optimize clinician performance. Curr Opin Anaesthesiol 2022; 35:723-727. [PMID: 36302211 DOI: 10.1097/aco.0000000000001193] [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: 06/16/2023]
Abstract
PURPOSE OF REVIEW Checklists and other cognitive aids serve multiple purposes in the peri-operative setting and have become nearly ubiquitous in healthcare. This review lays out the evidence for their use, shortcomings and pitfalls to be aware of, and how technology and innovation may improve checklist and cognitive aid relevance and usability. RECENT FINDINGS It has been difficult to show a direct link between the use of checklists alone and patient outcomes, but simulation studies have repeatedly demonstrated an association between checklist or cognitive aid use and improved performance. When implemented as part of a bundle of interventions, checklists likely have a positive impact, but the benefit of checklists and other cognitive aids may be both context- and user dependent. Advances in technology and automation demonstrate promise, but usability, design, and implementation research in this area are necessary to maximize effectiveness. SUMMARY Cognitive aids like checklists are powerful tools in the perioperative and critical care setting. Further research and innovation may elevate what is possible by improving the usability and relevance of these tools, possibly translating into improved patient outcomes.
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Affiliation(s)
- Rodrigo J Daly Guris
- Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania
- Children's Hospital of Philadelphia
- Center for Leadership and Innovation in Medical Education
- Center for Simulation, Advanced Education and Innovation, Children's Hospital of Philadelphia
| | - Meghan B Lane-Fall
- Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania
- Penn Center for Perioperative Outcomes Research and Transformation
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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16
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Tilley L, Schuler K, Cole R, Fahlsing C, Rudinsky S, Peters S, Goolsby C. Military Medical Provider Perspectives During the New York COVID-19 Response. Mil Med 2022; 188:e1260-e1267. [PMID: 36369894 DOI: 10.1093/milmed/usac338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/13/2022] [Accepted: 10/18/2022] [Indexed: 11/15/2022] Open
Abstract
ABSTRACT
Introduction
The response to the coronavirus disease 2019 pandemic in New York City (NYC) included unprecedented support from the DoD—a response limited primarily to medical and public health response on domestic soil with intact infrastructure. This study seeks to identify the common perspectives, experiences, and challenges of DoD personnel participating in this historic response.
Materials and Methods
This is a phenomenological qualitative study of 16 military health care providers who deployed to NYC in March 2020. This study was approved by the Institutional Review Board at the USU (No. DBS.2020.123). All participants served on either the United States Naval Ship Comfort or at the Javits Center. We conducted semi-structured interviews exploring the participants’ experiences while deployed to NYC. These interview scripts were then independently coded by five research team members.
Results
We identified four common themes and 12 subthemes from the participants’ responses. The themes (subthemes) were lack of preparation (unfamiliar mission and inadequate resources); confusion about integration with civilian health care (widespread, dynamic situation, and NYC overwhelmed), communication challenges (overall, misunderstanding and miscommunication resulting in tension, and patient handoffs); and adaptation and success (general, military–civilian liaison service, positive experience, and military support necessity).
Conclusions
This study provides unique insight into the DoD’s initial response to the coronavirus disease 2019 pandemic in NYC. Using this experiential feedback from the DoD’s pandemic responders could aid planners in improving the rapidity, effectiveness, and safety of military and civilian health care system integrations that may arise in the future.
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Affiliation(s)
- Laura Tilley
- Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences , Bethesda, MD 20814, USA
| | - Keke Schuler
- National Center for Disaster Medicine and Public Health , Rockville, MD 20852, USA
- The Henry M Jackson Foundation for the Advancement of Military Medicine, Inc. , Bethesda, MD 20817, USA
| | - Rebekah Cole
- Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences , Bethesda, MD 20814, USA
| | - Christopher Fahlsing
- School of Medicine, Uniformed Services University of the Health Sciences , Bethesda, MD 20814, USA
| | - Sherri Rudinsky
- Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences , Bethesda, MD 20814, USA
| | - Sidney Peters
- School of Medicine, Uniformed Services University of the Health Sciences , Bethesda, MD 20814, USA
| | - Craig Goolsby
- Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences , Bethesda, MD 20814, USA
- National Center for Disaster Medicine and Public Health , Rockville, MD 20852, USA
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17
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Abstract
OBJECTIVES To assess recent advances in interfacility critical care transport. DATA SOURCES PubMed English language publications plus chapters and professional organization publications. STUDY SELECTION Manuscripts including practice manuals and standard (1990-2021) focused on interfacility transport of critically ill patients. DATA EXTRACTION Review of society guidelines, legislative requirements, objective measures of outcomes, and transport practice standards occurred in work groups assessing definitions and foundations of interfacility transport, transport team composition, and transport specific considerations. Qualitative analysis was performed to characterize current science regarding interfacility transport. DATA SYNTHESIS The Task Force conducted an integrative review of 496 manuscripts combined with 120 from the authors' collections including nonpeer reviewed publications. After title and abstract screening, 40 underwent full-text review, of which 21 remained for qualitative synthesis. CONCLUSIONS Since 2004, there have been numerous advances in critical care interfacility transport. Clinical deterioration may be mitigated by appropriate patient selection, pretransport optimization, and transport by a well-resourced team and vehicle. There remains a dearth of high-quality controlled studies, but notable advances in monitoring, en route management, transport modality (air vs ground), as well as team composition and training serve as foundations for future inquiry. Guidance from professional organizations remains uncoupled from enforceable regulations, impeding standardization of transport program quality assessment and verification.
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18
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Hebballi NB, Gupta VS, Sheppard K, Kubanda A, Salley D, Ostovar-Kermani T, Bryndzia C, Khan AM, Wadhwa N, Tsao K, Jain R, Kawaguchi AL. Standardization of Pediatric Noncardiac Operating Room to Intensive Care Unit Handoffs Improves Communication and Patient Care. J Patient Saf 2022; 18:e1021-e1026. [PMID: 35985048 DOI: 10.1097/pts.0000000000000986] [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: 11/26/2022]
Abstract
OBJECTIVES Handoffs are critical points in transitioning care between multidisciplinary teams, yet data regarding intensive care unit (ICU) handoffs in pediatric noncardiac surgical patients are lacking. We hypothesized that standardized handoffs from the pediatric operating room (OR) to the ICU would improve physician presence, communication, and patient care parameters. METHODS This quality improvement initiative was performed at a tertiary children's hospital. Stakeholders (anesthesiologists, nurses, intensivists, and surgeons) developed a standardized OR to pediatric and neonatal ICU handoff process based on common goals and outcomes of interest. Baseline data were collected before intervention. Implementation was carried out in 2 phases, phase 1 with a written handoff and Phase 2 with a scripted handoff process. Data collected by trained observers included handoff attendance, distractions, and transfer of essential patient information. As a surrogate for outcomes, patient care parameter data were collected for 6 hours after transfer. RESULTS After phase 1, surgery and ICU physician attendance increased significantly, distractions decreased, and communication of essential patient data improved. In phase 2 (scripted handoff), attendance continued to rise, distractions remained decreased, and transfer of essential information was still improved compared with baseline. Mean handoff duration did not significantly change throughout the study. Certain patient care parameters (escalation of respiratory support, additional laboratory studies, vasopressor administration, antibiotic administration and timing) remained unchanged compared with baseline. However, the need for resuscitative fluid bolus or blood products significantly decreased after implementation phase 2. CONCLUSIONS Standardized handoffs for pediatric noncardiac surgical patients from the OR to the ICU can improve provider attendance and communication.
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Affiliation(s)
- Nutan B Hebballi
- From the Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston
| | - Vikas S Gupta
- From the Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston
| | - Kyle Sheppard
- From the Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston
| | | | | | - Tiffany Ostovar-Kermani
- From the Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston
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19
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Toren O, Lipschuetz M, Lehmann A, Regev G, Arad D. Improving Patient Safety in General Hospitals Using Structured Handoffs: Outcomes From a National Project. Front Public Health 2022; 10:777678. [PMID: 35372215 PMCID: PMC8965813 DOI: 10.3389/fpubh.2022.777678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 02/16/2022] [Indexed: 11/21/2022] Open
Abstract
Background Promoting quality and patient safety is one of the health policy pillars of Israel's Ministry of Health. Communication among healthcare professionals is of utmost importance and can be improved using a standardized, well-known handoff tool such as the Introduction, Situation, Background, Assessment, and Recommendations (ISBAR). This study aims to present implementation process and participants' satisfaction of a national project that used a standardized tool for team communication. Methods This national intervention project included process implementation teams from 17 Israeli general hospitals evaluating the ISBAR implementation process for transferring patients from intensive care units to medical/surgical wards. The project, conducted between January 2017 and March 2018, used Fischer's test and logistic regression. The project evaluation was based on the participants' assessment of and satisfaction with the handoff process. Results Eighty-seven process implementers completed the questionnaire. A statistically significant increase in satisfaction scores in terms of four variables (p < 0.001) was observed following the implementation of the project. Nurses reported higher satisfaction at the end of the process (0.036). Participants who perceived less missing information during handoffs were more satisfied with the process of information flow between wards (84.9%) than those who perceived more missing information (15.6%). Participants who responded that there was no need to improve information flow were more satisfied with the project information flow (95.6%) compared to the group which responded that it was necessary to improve information flow (58.2%). Three out of four variables predicted satisfaction with the process. Being a nurse also predicted satisfaction with information flow with a point estimate of 2.4. The C value of the total model was 0.87. Conclusions Implementation of a safety project at a national level requires careful planning and the close involvement of the participating teams. A standardized instrument, a well-defined process, and external controls to monitor and manage the project are essential for success. Disparities found in the responses of nurses vs. physicians suggest the need for a different approach for each profession in planning and executing a similar project in the future.
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Affiliation(s)
- Orly Toren
- Patient Safety and Risk Management, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.,Nursing Department, Ono Academic College, Kiryat Ono, Israel
| | - Michal Lipschuetz
- Patient Safety and Risk Management, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | | | - Gil Regev
- Psyfas, Teamwork and Healthcare, Herzliya, Israel
| | - Dana Arad
- Patient Safety Division, The Israeli Ministry of Health, Jerusalem, Israel
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20
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Wooldridge AR, Carayon P, Hoonakker P, Hose BZ, Schroeer K, Brazelton T, Eithun B, Rusy D, Ross J, Kohler J, Kelly MM, Dean S, Springman S, Rahal R, Gurses AP. Care transition of trauma patients: Processes with articulation work before and after handoff. APPLIED ERGONOMICS 2022; 98:103606. [PMID: 34638036 PMCID: PMC10373374 DOI: 10.1016/j.apergo.2021.103606] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 09/23/2021] [Accepted: 10/05/2021] [Indexed: 06/13/2023]
Abstract
While care transitions influence quality of care, less work studies transitions between hospital units. We studied care transitions from the operating room (OR) to pediatric and adult intensive critical care units (ICU) using Systems Engineering Initiative for Patient Safety (SEIPS)-based process modeling. We interviewed twenty-nine physicians (surgery, anesthesia, pediatric critical care) and nurses (OR, ICU) and administered the AHRQ Hospital Survey on Patient Safety Culture items about handoffs, care transitions and teamwork. Care transitions are complex, spatio-temporal processes and involve work during the transition (i.e., handoff and transport) and preparation and follow up activities (i.e., articulation work). Physicians defined the transition as starting earlier and ending later than nurses. Clinicians in the OR to adult ICU transition without a team handoff reported significantly less information loss and better cooperation, despite positive interview data. A team handoff and supporting articulation work should increase awareness, improving quality and safety of care transitions.
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Affiliation(s)
- Abigail R Wooldridge
- Department of Industrial and Enterprise Systems Engineering, University of Illinois at Urbana-Champaign, Urbana, IL, USA.
| | - Pascale Carayon
- Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin, Madison, USA; Department of Industrial and Systems Engineering, University of Wisconsin, Madison, USA
| | - Peter Hoonakker
- Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin, Madison, USA
| | - Bat-Zion Hose
- Department of Anesthesiology and Critical Care at the Perelman School of Medicine, University of Pennsylvania, USA
| | - Katherine Schroeer
- Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin, Madison, USA; Department of Industrial and Systems Engineering, University of Wisconsin, Madison, USA
| | - Tom Brazelton
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Ben Eithun
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Deborah Rusy
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Joshua Ross
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | | | - Michelle M Kelly
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Shannon Dean
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Scott Springman
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Rima Rahal
- Vituity, Mercy General Hospital and Sutter Medical Center, Sacramento, CA, USA
| | - Ayse P Gurses
- Center for Health Care Human Factors, Armstrong Institute for Patient Safety and Quality, Schools of Medicine, Bloomberg School of Public Health and Whiting School of Engineering, Johns Hopkins University, Baltimore, MD, USA
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21
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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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22
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The PATH to patient safety. Br J Anaesth 2021; 127:830-833. [PMID: 34635288 DOI: 10.1016/j.bja.2021.09.006] [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: 07/31/2021] [Revised: 09/10/2021] [Accepted: 09/12/2021] [Indexed: 11/22/2022] Open
Abstract
Communication is critical to safe patient care. In this issue of the British Journal of Anaesthesia, Jaulin and colleagues show that use of a Post-Anaesthesia Team Handover (PATH) checklist is associated with fewer hypoxaemia events in the PACU, reduced handover interruptions, and other important metrics related to improved communication. The PATH checklist provides a link within a broader chain of safety checklists and other interventions that comprise a perioperative chain of survival.
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23
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Lupei M, Munshi N, Kaizer AM, Patten L, Wahr J. Implementation and 1-year follow-up of the cardiovascular ICU standardised handover. BMJ Open Qual 2021; 10:bmjoq-2020-001063. [PMID: 34518301 PMCID: PMC8438901 DOI: 10.1136/bmjoq-2020-001063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 08/28/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Miscommunication during clinical handover can lead to partial information transfer and healthcare provider dissatisfaction. We hypothesised that a quality improvement project to standardise the cardiovascular intensive care unit (CVICU) handover could improve healthcare provider satisfaction and reduce information omission. METHODS After institutional review board approval, the operating room (OR) to CVICU handover was audited prior, post and 1 year after standardisation implementation. The medical information transferred, healthcare provider participation and satisfaction, and patient outcome data were collected. Additionally, surveys were sent to the OR and CVICU staff by email. RESULTS There were 68 handover processes observed. The odds of greater satisfaction with handover for providers were 18 times higher with the process post implementation (p<0.0001) and 26 times higher 1 year after implementation (p<0.0001). There was statistically significant difference between intensive care unit resident presence (45% vs 76% vs 91%, p=0.004), surgical faculty presence (10% vs 36% vs 45%, p=0.034) and surgical fellow presence (15% vs 64% vs 62%, p=0.001) between the three time periods. More information related to the surgeon (5% vs 52% vs 27%, p=0.002), the medical history (65% vs 96% vs 91%, p=0.014) and the cardiopulmonary bypass (47% vs 88% vs 76%, p=0.017) was conveyed. The duration of mechanical ventilation was shorter after implementation (2.2±2.6 days vs 1.2±1.9 days vs 0.5±1.2 days, p=0.026). CONCLUSIONS One year after the OR to CVICU standardised handover implementation, the healthcare provider satisfaction remained increased, more team members participated and the information transfer increased. Although some clinical outcomes improved, further studies are recommended to prove causality.
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Affiliation(s)
- Monica Lupei
- Anesthesiology, University of Minnesota School of Medicine, Minneapolis, Minnesota, USA
| | - Nishkruti Munshi
- Anesthesiology, Baystate Medical Center, Springfield, Massachusetts, USA
| | - Alexander M Kaizer
- Department of Biostatistics and Informatics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Luke Patten
- Department of Biostatistics and Informatics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Joyce Wahr
- Anesthesiology, University of Minnesota School of Medicine, Minneapolis, Minnesota, USA
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24
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Center-Level Procedure Volume Does Not Predict Failure-to-Rescue After Severe Complications of Oncologic Colon and Rectal Surgery. World J Surg 2021; 45:3695-3706. [PMID: 34448919 PMCID: PMC8572842 DOI: 10.1007/s00268-021-06296-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2021] [Indexed: 11/22/2022]
Abstract
Background The relationship between hospital surgical volume and outcome after colorectal cancer surgery has thoroughly been studied. However, few studies have assessed hospital surgical volume and failure-to-rescue (FTR) after colon and rectal cancer surgery. The aim of the current study is to evaluate FTR following colorectal cancer surgery between clinics based on procedure volume. Methods Patients undergoing colorectal cancer surgery in Sweden from January 2015 to January 2020 were recruited through the Swedish Colorectal Cancer Registry. The primary endpoint was FTR, defined as the proportion of patients with 30-day mortality after severe postoperative complications in colorectal cancer surgery. Severe postoperative complications were defined as Clavien–Dindo ≥ 3. FTR incidence rate ratios (IRR) were calculated comparing center volume stratified in low-volume (≤ 200 cases/year) and high-volume centers (> 200 cases/year), as well as with an alternative stratification comparing low-volume (< 50 cases/year), medium-volume (50–150 cases/year) and high-volume centers (> 150 cases/year). Results A total of 23,351 patients were included in this study, of whom 2964 suffered severe postoperative complication(s). Adjusted IRR showed no significant differences between high- and low-volume centers with an IRR of 0.97 (0.75–1.26, p = 0.844) in high-volume centers in the first stratification and an IRR of 2.06 (0.80–5.31, p = 0.134) for high-volume centers and 2.15 (0.83–5.56, p = 0.116) for medium-volume centers in the second stratification. Conclusion This nationwide retrospectively analyzed cohort study fails to demonstrate a significant association between hospital surgical volume and FTR after colorectal cancer surgery. Future studies should explore alternative characteristics and their correlation with FTR to identify possible interventions for the improvement of quality of care after colorectal cancer surgery.
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25
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Bass GA, Dzierba AL, Taylor B, Lane-Fall M, Kaplan LJ. Tertiary peritonitis: considerations for complex team-based care. Eur J Trauma Emerg Surg 2021; 48:811-825. [PMID: 34302503 PMCID: PMC8308068 DOI: 10.1007/s00068-021-01750-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 07/18/2021] [Indexed: 12/14/2022]
Abstract
Peritonitis, as a major consequence of hollow visceral perforation, anastomotic disruption, ischemic necrosis, or other injuries of the gastrointestinal tract, often drives acute care in the emergency department, operating room, and the ICU. Chronic critical illness (CCI) represents a devastating challenge in modern surgical critical care where successful interventions have fostered a growing cohort of patients with prolonged dependence on mechanical ventilation and other organ supportive therapies who would previously have succumbed much earlier in the acute phase of critical illness. An important subset of CCI patients are those who have survived an emergency abdominal operation, but who subsequently require prolonged open abdomen management complicated by persistent peritoneal space infection or colonization, fistula formation, and gastrointestinal (GI) tract dysfunction; these patients are described as having tertiary peritonitis (TP).The organ dysfunction cascade in TP terminates in death in between 30 and 64% of patients. This narrative review describes key—but not all—elements in a framework for the coordinate multiprofessional team-based management of a patient with tertiary peritonitis to mitigate this risk of death and promote recovery. Given the prolonged critical illness course of this unique patient population, early and recurrent Palliative Care Medicine consultation helps establish goals of care, support adjustment to changes in life circumstance, and enable patient and family centered care.
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Affiliation(s)
- Gary Alan Bass
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine, University of Pennsylvania, 51 N. 39th Street, MOB 1, Suite 120, Philadelphia, PA 19104 USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, USA
- European Society of Trauma and Emergency Surgery, Visceral Trauma Section, Philadelphia, USA
| | - Amy L. Dzierba
- Department of Pharmacy, New York-Presbyterian Hospital, Columbia University Irving Medical Center, New York, NY USA
| | - Beth Taylor
- Department of Research for Patient Care Services, Barnes-Jewish Hospital, St. Louis, MO USA
| | - Meghan Lane-Fall
- Department of Anesthesia and Critical Care, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, 5 Dulles, Philadelphia, PA 19104 USA
| | - Lewis J. Kaplan
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine, University of Pennsylvania, 51 N. 39th Street, MOB 1, Suite 120, Philadelphia, PA 19104 USA
- Surgical Services, Section of Surgical Critical Care, Corporal Michael J Crescenz VA Medical Center, 3900 Woodland Avenue, Philadelphia, PA 19104 USA
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Arriaga AF, Chen YYK, Kim JJ, Bader AM. Toward a Blueprint for Perioperative Handoffs and Handoff Tools. Anesth Analg 2021; 132:1559-1562. [PMID: 34032659 DOI: 10.1213/ane.0000000000005514] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Alexander F Arriaga
- From the Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,Center for Surgery and Public Health, Boston, Massachusetts.,Ariadne Labs, Boston, Massachusetts
| | - Yun-Yun K Chen
- From the Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Jimin J Kim
- From the Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Angela M Bader
- From the Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,Center for Surgery and Public Health, Boston, Massachusetts
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27
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Lane-Fall MB, Christakos A, Russell GC, Hose BZ, Dauer ED, Greilich PE, Hong Mershon B, Potestio CP, Pukenas EW, Kimberly JR, Stephens-Shields AJ, Trotta RL, Beidas RS, Bass EJ. Handoffs and transitions in critical care-understanding scalability: study protocol for a multicenter stepped wedge type 2 hybrid effectiveness-implementation trial. Implement Sci 2021; 16:63. [PMID: 34130725 PMCID: PMC8204062 DOI: 10.1186/s13012-021-01131-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 05/26/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The implementation of evidence-based practices in critical care faces specific challenges, including intense time pressure and patient acuity. These challenges result in evidence-to-practice gaps that diminish the impact of proven-effective interventions for patients requiring intensive care unit support. Research is needed to understand and address implementation determinants in critical care settings. METHODS The Handoffs and Transitions in Critical Care-Understanding Scalability (HATRICC-US) study is a Type 2 hybrid effectiveness-implementation trial of standardized operating room (OR) to intensive care unit (ICU) handoffs. This mixed methods study will use a stepped wedge design with randomized roll out to test the effectiveness of a customized protocol for structuring communication between clinicians in the OR and the ICU. The study will be conducted in twelve ICUs (10 adult, 2 pediatric) based in five United States academic health systems. Contextual inquiry incorporating implementation science, systems engineering, and human factors engineering approaches will guide both protocol customization and identification of protocol implementation determinants. Implementation mapping will be used to select appropriate implementation strategies for each setting. Human-centered design will be used to create a digital toolkit for dissemination of study findings. The primary implementation outcome will be fidelity to the customized handoff protocol (unit of analysis: handoff). The primary effectiveness outcome will be a composite measure of new-onset organ failure cases (unit of analysis: ICU). DISCUSSION The HATRICC-US study will customize, implement, and evaluate standardized procedures for OR to ICU handoffs in a heterogenous group of United States academic medical center intensive care units. Findings from this study have the potential to improve postsurgical communication, decrease adverse clinical outcomes, and inform the implementation of other evidence-based practices in critical care settings. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT04571749 . Date of registration: October 1, 2020.
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Affiliation(s)
| | - Athena Christakos
- , 3400 Spruce Street 6th Floor Dulles Building, Philadelphia, PA, 19104, USA
| | - Gina C Russell
- , 3400 Civic Center Boulevard, Building 421, Philadelphia, PA, 19104, USA
| | - Bat-Zion Hose
- , 423 Guardian Drive, 333 Blockley Hall, Philadelphia, PA, 19104, USA
| | | | | | | | | | | | - John R Kimberly
- , 3620 Locust Walk, 2109 Steinberg-Dietrich Hall, Philadelphia, PA, 19104, USA
| | | | | | - Rinad S Beidas
- , 3535 Market Street, Ste 3105, Philadelphia, PA, 19104, USA
| | - Ellen J Bass
- Drexel University, 3675 Market Street, Suite 1000, Philadelphia, PA, 19104, USA
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Abstract
OBJECTIVES To examine adverse events and associated factors and outcomes during transition from ICU to hospital ward (after ICU discharge). DESIGN Multicenter cohort study. SETTING Ten adult medical-surgical Canadian ICUs. PATIENTS Patients were those admitted to one of the 10 ICUs from July 2014 to January 2016. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Two ICU physicians independently reviewed progress and consultation notes documented in the medical record within 7 days of patient's ICU discharge date to identify and classify adverse events. The adverse event data were linked to patient characteristics and ICU and ward physician surveys collected during the larger prospective cohort study. Analyses were conducted using multivariable logistic regression. Of the 451 patients included in the study, 84 (19%) experienced an adverse event, the majority (62%) within 3 days of transfer from ICU to hospital ward. Most adverse events resulted only in symptoms (77%) and 36% were judged to be preventable. Patients with adverse events were more likely to be readmitted to the ICU (odds ratio, 5.5; 95% CI, 2.4-13.0), have a longer hospital stay (mean difference, 16.1 d; 95% CI, 8.4-23.7) or die in hospital (odds ratio, 4.6; 95% CI, 1.8-11.8) than those without an adverse event. ICU and ward physician predictions at the time of ICU discharge had low sensitivity and specificity for predicting adverse events, ICU readmissions, and hospital death. CONCLUSIONS Adverse events are common after ICU discharge to hospital ward and are associated with ICU readmission, increased hospital length of stay and death and are not predicted by ICU or ward physicians.
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Abraham J, King CR, Meng A. Ascertaining Design Requirements for Postoperative Care Transition Interventions. Appl Clin Inform 2021; 12:107-115. [PMID: 33626584 DOI: 10.1055/s-0040-1721780] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Handoffs or care transitions from the operating room (OR) to intensive care unit (ICU) are fragmented and vulnerable to communication errors. Although protocols and checklists for standardization help reduce errors, such interventions suffer from limited sustainability. An unexplored aspect is the potential role of developing personalized postoperative transition interventions using artificial intelligence (AI)-generated risks. OBJECTIVES This study was aimed to (1) identify factors affecting sustainability of handoff standardization, (2) utilize a human-centered approach to develop design ideas and prototyping requirements for a sustainable handoff intervention, and (3) explore the potential role for AI risk assessment during handoffs. METHODS We conducted four design workshops with 24 participants representing OR and ICU teams at a large medical academic center. Data collection phases were (1) open-ended questions, (2) closed card sorting of handoff information elements, and (3) scenario-based design ideation and prototyping for a handoff intervention. Data were analyzed using thematic analysis. Card sorts were further tallied to characterize handoff information elements as core, flexible, or unnecessary. RESULTS Limited protocol awareness among clinicians and lack of an interdisciplinary electronic health record (EHR)-integrated handoff intervention prevented long-term sustainability of handoff standardization. Clinicians argued for a handoff intervention comprised of core elements (included for all patients) and flexible elements (tailored by patient condition and risks). They also identified unnecessary elements that could be omitted during handoffs. Similarities and differences in handoff intervention requirements among physicians and nurses were noted; in particular, clinicians expressed divergent views on the role of AI-generated postoperative risks. CONCLUSION Current postoperative handoff interventions focus largely on standardization of information transfer and handoff processes. Our design approach allowed us to visualize accurate models of user expectations for effective interdisciplinary communication. Insights from this study point toward EHR-integrated, "flexibly standardized" care transition interventions that can automatically generate a patient-centered summary and risk-based report.
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Affiliation(s)
- Joanna Abraham
- Department of Anesthesiology, School of Medicine, Washington University, St. Louis, Missouri, United States.,Institute for Informatics, Department of Medicine, School of Medicine, Washington University in St. Louis, Missouri, United States
| | - Christopher R King
- Department of Anesthesiology, School of Medicine, Washington University, St. Louis, Missouri, United States
| | - Alicia Meng
- Department of Anesthesiology, School of Medicine, Washington University, St. Louis, Missouri, United States
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Abraham J, Meng A, Tripathy S, Avidan MS, Kannampallil T. Systematic review and meta-analysis of interventions for operating room to intensive care unit handoffs. BMJ Qual Saf 2021; 30:513-524. [PMID: 33563791 DOI: 10.1136/bmjqs-2020-012474] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 01/23/2021] [Accepted: 01/26/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To 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. METHOD We 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. RESULTS 32 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. DISCUSSION Bundled 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.
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Affiliation(s)
- Joanna Abraham
- Department of Anesthesiology, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
| | - Alicia Meng
- Department of Anesthesiology, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
| | | | - Michael S Avidan
- Department of Anesthesiology, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
| | - Thomas Kannampallil
- Department of Anesthesiology, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
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Sauro K, Maini A, Machan M, Lorenzetti D, Chandarana S, Dort J. Are there opportunities to improve care as patients transition through the cancer care continuum? A scoping review protocol. BMJ Open 2021; 11:e043374. [PMID: 33495258 PMCID: PMC7839915 DOI: 10.1136/bmjopen-2020-043374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Transitions in Care (TiC) are vulnerable periods in care delivery associated with adverse events, increased cost and decreased patient satisfaction. Patients with cancer encounter many transitions during their care journey due to improved survival rates and the complexity of treatment. Collectively, improving TiC is particularly important among patients with cancer. The objective of this scoping review is to synthesise and map the existing literature regarding TiC among patients with cancer in order to explore opportunities to improve TiC among patients with cancer. METHODS AND ANALYSIS This scoping review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analysis-Scoping Review Extension and the Joanna Briggs Institute methodology. The PubMed cancer filter and underlying search strategy will be tailored to each database (Embase, Cochrane, CINAHL and PsycINFO) and combined with search terms for TiC. Grey literature and references of included studies will be searched. The search will include studies published from database inception until 9 February 2020. Quantitative and qualitative studies will be included if they describe transitions between any type of healthcare provider or institution among patients with cancer. Descriptive statistics will summarise study characteristics and quantitative data of included studies. Qualitative data will be synthesised using thematic analysis. ETHICS AND DISSEMINATION Our objective is to synthesise and map the existing evidence; therefore, ethical approval is not required. Evidence gaps around TiC will inform a programme of research aimed to improve high-risk transitions among patients with cancer. The findings of this scoping review will be published in a peer-reviewed journal and widely presented at academic conferences. More importantly, decision makers and patients will be provided a summary of the findings, along with data from a companion study, to prioritise TiC in need of interventions to improve continuity of care for patients with cancer.
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Affiliation(s)
- Khara Sauro
- Department of Community Health Sciences & O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Oncology & Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Arjun Maini
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Matthew Machan
- Department of Community Health Sciences & O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Diane Lorenzetti
- Department of Community Health Sciences & O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Shamir Chandarana
- Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Joseph Dort
- Department of Community Health Sciences & O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Oncology & Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Interprofessional Training and Communication Practices Among Clinicians in the Postoperative ICU Handoff. Jt Comm J Qual Patient Saf 2020; 47:242-249. [PMID: 33451897 DOI: 10.1016/j.jcjq.2020.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 12/02/2020] [Accepted: 12/04/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Operating room (OR)-to-ICU handoffs require coordinated communication between clinicians with different professional backgrounds. However, individual studies have not simultaneously evaluated handoff training and OR-to-ICU handoff practices among interprofessional clinicians that participate in these team-based handoffs. METHODS The objective of this study was to characterize communication training, practices, and preferences of interprofessional clinicians who engage in OR-to-ICU handoffs. The researchers conducted a mixed methods cohort study using surveys (quantitative) and semistructured interviews (qualitative). Surveys aimed to quantitatively assess the quality of prior handoff training, preferences for clinical information in handoffs, and participation in various handoff activities. Interviews aimed to elicit more in-depth clinician perspectives on these topics through open-ended discussion. The frontline clinicians who were surveyed and interviewed included surgery and anesthesia residents, registered nurses, and advanced practice providers who worked in two ICUs at an urban academic medical center in the United States. RESULTS In a survey with a 71.8% response rate (130/181), 45.7% (32/70) of residents, 17.4% (4/23) of certified registered nurse anesthetists (CRNAs), 83.3% (10/12) of ICU nurse practitioners (NPs), and 81.0% (17/21) of ICU RNs indicated that their clinical degree-granting education had not provided adequate preparation for OR-to-ICU handoffs. On-the-job training was deemed not adequate preparation by 35.7% (25/70) of residents, 21.7% (5/23) of CRNAs, 58.3% (7/12) of ICU NPs, and 23.8% (5/21) of ICU RNs. Through 30 semistructured interviews, clinicians from all professions expressed interest in interprofessional communication education and in understanding the perspectives and priorities of care team members in OR-to-ICU handoffs. Clinicians also highlighted the potential value of interprofessional communication training taking place early in a clinical career, during degree-granting education. CONCLUSION Clinicians exhibit profession-based differences in OR-to-ICU handoff training, practices, and information needs. Education focused on interprofessional communication is a potential approach to facilitate improved OR-to-ICU handoff communication.
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