Background: In medicine, a handoff occurs anytime the care of patient transitions between providers, services or locations in the hospital. One common place handoffs occur is between the anesthesia and ICU care teams.... [ view full abstract ]
Background: In medicine, a handoff occurs anytime the care of patient transitions between providers, services or locations in the hospital. One common place handoffs occur is between the anesthesia and ICU care teams. Several variables make handoffs a potentially dangerous time for patients. A large amount of information needs to be conveyed in an efficient manner, including the patient’s medical history, hospital and surgical course and future care plans. During the handoff process, patient care must also be conducted including treatment of any post-operative derangements. Effective communication can be difficult because of providers’ different backgrounds in training and care priorities. The problem of poor handoffs leading to worse outcomes is well documented. A recent study showed an increase in hospital mortality from 1.5% to 1.9% in patient’s exposed to an end of rotation transition between medical residents. The presence of a handoff checklist is known to improve the handoff process.
Methods: This QI project implemented an OR to ICU handoff checklist in a hospital where there was not a standardized process in place. The effect on handoffs was tracked by a satisfaction questionnaire voluntarily filled out by hospital physicians and staff who partake in the handoffs.
To develop the handoff checklist, a series of meetings were convened with stakeholder leadership from the Departments of Anesthesiology and Surgery that oversee the SICU. A handoff checklist was developed using best practices and stakeholder input and put into place during the spring of 2016. The checklist focused on four priorities: complete information, efficient delivery, presence and attention of all team members without interruption and compliance with the checklist.
An anonymous pre-survey was administered to all resident physicians, CRNAs, ICU RNs and ICU advanced practice practitioners working or rotating at the hospital in December of 2015. The survey consisted of eight Likert scale questions asking about satisfaction with the current hand-off process as well as specific components in the handoff process. A year later the same survey was distributed. Survey results were tallied in Microsoft Excel and a two-tailed T-test was administered with a 0.05 significance. A total of 21 pre-surveys and 23 post-surveys were collected.
Results and Conclusions: One year after the handoff checklist was implemented satisfaction in OR and ICU staff had improved (p=0.003). Specific questions about efficiency (p=0.053) and completeness (p=0.623) did not however show a significant difference. One conclusion is that although satisfaction improved (possibly just by increased attention to the issue) quality of handoffs did not improve significantly. A more optimistic conclusion is that handoff satisfaction improved and specific improvements were made but not captured in the survey. Ideally we would have liked to track which components of the handoffs improved and which did not to guide future improvement efforts. Moving forward the checklist has now become part of the anesthesia record and handoff start and ends times are being collected to track efficiency. Simulator training is also starting to help teach efficient handoffs. These efforts will be tracked with future surveys and metrics for continued improvement.
