A scripted handoff template ensures relevant information is delivered
One of the most complex environments for the transfer of information is in the perioperative unit. When the responsibility of care shifts from one clinician to another (“the handoff”), it’s time to ask relevant questions, clarify details, and confirm the plan of care.
Communication Gaps Cause Harm
Patients can experience the handoff of a report during the perioperative process up to 4.8 times.1 Nurses in the pediatric daystay surgery center at Baystate Medical Center in Springfield, Mass., were concerned that information during handoff from the operating room (OR) to the pediatric post-anesthesia care unit (PPACU) was not always sufficiently comprehensive.
Communication breakdowns can cause decreased quality of care, increased length of stay, injury or harm-all of which may lead to increased cost of care and time spent recovering.2 Miscommunication has been reported by the Joint Commission to be responsible for up to 79.5% of hospital sentinel events in 2015.3
Brainstorming Improvements
Baystate nurses brainstormed improvements to the handoff process. What information was missing? Could communication be improved to increase patient safety and improve efficiency?2
The nurses performed a literature review and conducted a survey to determine what was missing during handoff. For a month, they collected data in a blind format from OR nurses, surgeons and anesthesia providers. Data were used to create a scripted handoff template that organized the presentation of relevant information and actions at handoff. The tool was then presented to perioperative staff via e-mail to invite suggestions and increase overall adoption. After appropriate staff education, the tool was implemented.
Outlining Dialogue and Actions
The scripted tool includes an outline of the dialogue and actions that anesthesia, OR nurses and surgical providers should include during handoff with the PPACU nurse. Actions on arrival include: verification of patient name, procedure performed and surgeon; assessment of airway patency and lungs; placing the patient on monitor; status assessment; opening of the EHR; and details of care provided, medications used, and orders for the plan of care. Each clinician has defined responsibilities for providing or accepting information, as well as actions to cover.
Becoming a ‘Best Practice’
The handoff metrics were measured at 1-month and 6-month intervals. Increases in comprehensive handoff information transfer were statistically significant over the 6-month trial. Anesthesiologist handoff metrics increased from 65% to 79%. Nurse handoff metrics, which included key elements of the anesthesia tool, increased from 40% to 67%.
The PPACU handoff metrics tool has improved communication with regard to patient requirements and increased transparency during transition of care, ultimately making the process safer. Nurses received positive feedback from the entire perioperative team. The PPACU handoff tool is now a “Baystate Best Practice,” and is being tested for use in a number of other units in the hospital.
References
1. Christian CK, et al. A prospective study of patient safety in the operating room. Surgery. 2006;139(2):159-173.
2. Whitney M, et al. OR to pediatric PACU handoff. J Perianesth Nurs. 2015;30(4):e24-e25.
3. The Joint Commission. Sentinel event data: root causes by event type, 2004-2015. https://www.jointcommission.org/sentinel_event_statistics/
