Background Evidence-based research demonstrates that postoperative formalized handoff improves communication and satisfaction among hospital staff members, leading to improved patient outcomes. Objective To improve postoperative patient safety in the surgical intensive care unit of a tertiary academic medical center. Methods A verbal and written formal reporting method was designed, implemented, and evaluated. The intervention created an admission "time-out," allowing the handoff from surgical and anesthesia teams to the intensive care unit team and bedside nurses to occur in a more structured manner. Before and 1 year after implementation of the intervention, nurses completed surveys on the quality of postoperative handoff. Results After the intervention, the proportion of nurses who reported receiving handoff from the surgical team increased from 20% to 60% (P < .001). More nurses felt satisfied with the surgical handoff (46% before vs 74% after the intervention; P < .001), and more nurses frequently felt included in the handoff process (42% vs 74%; P < .001). Nurses perceived improved communication with surgical teams (93%), anesthesia teams (89%), and the intensive care unit team (94%), resulting in a perception of better patient care (88%). Conclusion After implementation of a systematic multidisciplinary handoff process, surgical intensive care nurses reported improved frequency and completeness of the postoperative handoff process, resulting in a perception of better patient care. (Critical Care Nurse. 2019;39[5]:e13-e21

Rib osteomyelitis can be caused by a contiguous infection after a traumatic fracture. Post traumatic osteomyelitis can present as chronic six or more weeks after bone infection. However, this patient developed first rib osteomyelitis 17 years after trauma, following the initiation of anticoagulation therapy. 17 years ago, a 55-year-old male patient was in a motor vehicle collision. He was diagnosed with a left first rib fracture and an internal carotid dissection. He subsequently underwent a left subclavian central venous catheter placement. His rib fracture was managed nonoperatively and the carotid dissection was treated with endovascular stent placement. He now presents with symptomatic carotid stent stenosis which is treated with anti-platelet and anticoagulation therapy. He then developed a hematoma over the old rib fracture, and subsequently developed acute osteomyelitis. As seen here, a remote history of traumatic first rib fracture remains a risk factor for osteomyelitis despite the passage of time.

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Teamwork is essential for patient safety as highly functioning teams make fewer errors. In high acuity academic medical centers, care delivery is complex and ever-changing, creating a high-risk environment for safety concerns. These intricate settings demand a collaborative approach to care delivery, where structured methods of teamwork and communication are engrained in day-to-day practice. With teamwork being a critical component of patient safety and communication failures likened to preventable medical errors, hospitals are looking to bolster leadership training and improve team dynamics. TeamSTEPPS is a proven method shown to enhance teamwork, communication, leadership, and patient satisfaction. TeamSTEPPS provides an evidence-based framework to optimize patient outcomes by improving communication and teamwork skills among healthcare professionals. Current literature on teamwork and communication demonstrates that nurse practitioners are uniquely positioned to improve team performance through the use of the TeamSTEPPS framework.