Development of a Protocol to Improve Postoperative Handoffs

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Primary Author:</td>
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Jens Tan, MD</td>
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Co-Principal Investigators/Collaborators:</td>
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<p>Joseph Ruiz, MD, Jessica Hersey, CRNA, Sharon Carson, RN</p>
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Organization:</td>
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MD Anderson Cancer Center</td>
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Abstract</h2>
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Purpose</h3>
<p>We aimed to create a handoff protocol for the transfer of patients from the operating room (OR) to the post anesthetic care unit (PACU) in a large academic institution.</p>
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Background</h3>
<p align="left">Handoffs can be defined as the transition of care of patients from one team of caregivers to another within the same or between different institutional environments. They are a potential source of communication errors with resulting risks to patient safety. Considerable research has been conducted relating to patient transfers from the OR to the PACU, however very few studies describe quality improvement methods for developing and implementing handoff protocols. Currently, no formal postoperative handoff protocol exists at our institution.</p>
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Materials & Methods</h3>
<p>Two faculty anesthesiologists, a PACU nurse manager, and a certified registered nurse anesthetist (CRNA) completed an institutional quality improvement course. Leadership support from PACU nursing and anesthesiology was obtained. Using the Joint Commission’s online Handoff Tool, 4 baseline data of handoff “defects” was collected. The data were organized into a p-chart and Pareto chart (toolbox reference), which were displayed to all providers. Fishbone diagrams and flow charts were created to elucidate causes of suboptimal handoffs and determine points for interventions. </p>
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Results</h3>
<p>The p-chart calculated a baseline “defect” rate and the Pareto chart outlined contributing factors e.g. “interruptions occurred” and “no standard procedure” which were consistent with the literature. These results guided the creation of a handoff protocol with the following features: a flow diagram outlining the handoff process, environment changes (e.g. minimized interruptions), and standardized checklists. </p>
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Conclusion</h3>
<p>This project demonstrates that quality improvement tools can guide the development of a new handoff protocol which aims to improve patient safety through better communication during critical postoperative patient handoffs. </p>
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Bibliography</h3>
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Joint Commission Center for Transforming Healthcare. Targeted Solutions Tool for Hand-off Communications. (May 13, 2014). Retrieved from http://www.centerfortransforminghealthcare.org/tst_hoc.aspx</li>
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Manser T, Foster S, Flin R, Patey R (2013). Team communication during patient handover from the operating room: more than facts and figures. Human Factors: The Journal of the Human Factors and Ergonomics Society. 55(1), 138-56.</li>
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Moller TP, Madsen MD, Fuhrmann L et al. (2013). Postoperative handover: characteristics and considerations on improvement: a systematic review. European Journal of Anaesthesiology. 30(5):229-42.</li>
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Solet DJ, Norvell JM, Rutan GH, Frankel RM (2005). Lost in translation: challenges and opportunities in physician-to-physician communication during patient handoffs. Academic Medicine. 80(12), 1094-9.</li>
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<p>© Improvement Science Research Network, 2012</p>
<p>The ISRN published this as received and with permission from the author(s).</p>