Can We Make Postoperative Patient Handovers Safer? A Systematic Review of the Literature

Abstract

blood transfusion independently leads to an increase in mortality owing to cardiac ischemia, delayed wound healing, organ dysfunction, and transmission of infection. Patients requiring hip or knee surgery are often anemic preoperatively, and the rate of blood transfusion is relatively high. The authors identified the problems, introduced a simple patient blood management algorithm, and collected data after its implementation. They should be congratulated for reducing the prevalence of preoperative anemia, decreasing blood transfusion rates, and reducing the length of hospital stay. Patient blood management, including simple intraoperative measures such as cell salvage, meticulous attention to hemostasis, and judicious use of tranexamic acid, is just 1 facet of an enhanced recovery pathway. These interventions are becoming increasingly popular and include preoperative optimization, as well as general measures such as maintenance of normothermia, appropriate analgesia prescribing, prophylaxis of postoperative nausea and vomiting, and assessment for deep venous thrombosis risk, all of which are likely to improve overall patient outcome.

A Standard Handoff Improves Cardiac Surgical Patient Transfer

“…The perceived best addition to our handoff protocol was for team members to state what worried them most about the patient, which could lead to mitigation of adverse events. Finally, for optimal implementation, the environment needs to be one where all team members are allowed the opportunity to speak or ask questions without hierarchical structure (Segall et al, 2012). This was encouraged by our process development and educational phase; however, the protocol clearly defined the order of speakers to prevent confusion as to whose turn it was to speak.…”

“…The setting is a single-institution 635-bed teaching hospital, with a dedicated 14-bed cardiovascular surgery ICU. A multidisciplinary team including intensivists, surgeons, anesthesiologists, pharmacists, advanced practice nurses, physician assistants, respiratory therapists, and ICU nurses developed a formal handoff process based on the current literature (Petrovic et al, 2012a(Petrovic et al, , 2012bSegall et al, 2012). The process included critical handoff elements and a standardized handoff procedure, script, and detailed checklist for the surgeon and anesthesia provider (Figures 1 and 2) modified from those originally proposed by Petrovic et al, 2012b.…”

“…Common barriers include incomplete transfer of information, inaccurate information, lack of consistency or organization, distractions during the transfer, inconsistent or incomplete teams, and poor standardization (Segall et al, 2012). Checklists are emerging as a reliable method for standardized communication because of decreased mortality (Haynes et al, 2009;Neily et al, 2010).…”

Transition of Care in the Cardiothoracic Intensive Care Unit: A Review of Handoffs in Perioperative Cardiothoracic and Vascular Practice

“…[46][47][48][49] Multiple handoff electronic platforms ranging from an internet-based sign-out to smartphone-assisted techniques have been studied. [50][51][52][53][54] As a rule, a structured electronic handoff template tends to improves the quality, consistency, and reliability of handoffs in perioperative practice, compared with traditional techniques. [50][51][52][53][54] Physician-to-physician direct communication is easiest to facilitate when patients are transitioning among providers in the same geographic location (eg, within the intensive care unit) or when they are escorted between point-of-care locations by a physician.…”

“…[50][51][52][53][54] As a rule, a structured electronic handoff template tends to improves the quality, consistency, and reliability of handoffs in perioperative practice, compared with traditional techniques. [50][51][52][53][54] Physician-to-physician direct communication is easiest to facilitate when patients are transitioning among providers in the same geographic location (eg, within the intensive care unit) or when they are escorted between point-of-care locations by a physician. In the cardiothoracic intensive care unit, patients arriving from the operating room environment typically are accompanied by an anesthesiologist and a surgeon, thereby enabling face-to-face synchronous verbal handoff interactions.…”