Development of an orthopedic surgery trauma patient handover checklist

Abstract

Development of an orthopedic surgery trauma patient handover checklistBackground: In surgery, preoperative handover of surgical trauma patients is a process that must be made as safe as possible. We sought to determine vital clinical information to be transferred between patient care teams and to develop a standardized handover checklist. Methods:We conducted standardized small-group interviews about trauma patient handover. Based on this information, we created a questionnaire to gather perspectives from all Canadian Orthopaedic Association (COA) members about which topics they felt would be most important on a handover checklist. We analyzed the responses to develop a standardized handover checklist. Results:Of the 1106 COA members, 247 responded to the questionnaire. The top 7 topics felt to be most important for achieving patient safety in the handover were comorbidities, diagnosis, readiness for the operating room, stability, associated injuries, history/mechanism of injury and outstanding issues. The expert recommendations were to have handover completed the same way every day, all appropriate radiographs available, adequate time, all appropriate laboratory work and more time to spend with patients with more severe illness. Conclusion:Our main recommendations for safe handover are to use standardized checklists specific to the patient and site needs. We provide an example of a standardized checklist that should be used for preoperative handovers. To our knowledge, this is the first checklist for handover developed by a group of experts in orthopedic surgery, which is both manageable in length and simple to use.Contexte : En chirurgie, le transfert préopératoire des polytraumatisés nécessi-tant une chirurgie est un processus que l'on doit rendre aussi sécuritaire que possible. Nous avons voulu déterminer quels renseignements cliniques vitaux doivent être transmis aux équipes de soins et préparer une liste de vérification standardisée à cette fin.Méthodes : Nous avons réalisé des entrevues standardisées par petits groupes au sujet du transfert des polytraumatisés. À partir des renseignements recueillis, nous avons élaboré un questionnaire pour obtenir le point de vue de tous les membres de l'Association canadienne d'orthopédie (ACO) au sujet des élé-ments jugés les plus importants sur une liste de vérification en vue du transfert. Nous avons analysé les réponses pour dresser une liste de vérification standardisée.Résultats : Sur les 1106 membres de l'ACO, 247 ont répondu au questionnaire. Les 7 éléments jugés les plus importants pour assurer la sécurité des patients lors du transfert ont été : comorbidités, diagnostic, état de préparation pour le bloc opéra-toire, stabilité, blessures connexes, histoire et mécanisme du traumatisme et questions en suspens. Les recommandations des experts ont été les suivantes : que les transferts s'effectuent de la même façon chaque jour, qu'on obtienne toutes les radiographies appropriées disponibles, qu'on dispose de temps suffisant, qu'on obtienne toute les analyses de lab...

CHAracteristics of research studies that iNfluence practice: a GEneral survey of Canadian orthopaedic Surgeons (CHANGES): a pilot survey

“…While previous reports suggest that 90% of surgeons used RCTs to guide practice (Matzon et al 2013 ), that number is much lower in orthopaedic surgery - with only 25% and 46% of surgeons finding RCTs “extremely” and “somewhat” helpful, respectively (Khan et al 2013 ). The reasons for this are likely multi-factorial, with studies demonstrating surgeon preference (LeBlanc et al 2014 ), increasing patient education/pressure (McKinlay et al 2014 ), and challenges unique to practice setting and resource allocation (Farias-Kovac et al 2014 ) as critical in determining patient treatment – independent of sound evidence. Moreover, specialty-specific differences in training and decision-making (Fraenkel et al 2013 ) and/or the nature of the results (i.e.…”

Review article: Current literature on surgical checklists and handoff tools and application for orthopaedic surgery

“…As implementation costs for SSC comprise the majority of the expenses, savings could potentially be greater if analyzed for a prolonged study interval. 18 In a prospective study conducted by Haugen et al, a 40% cost reduction in blood transfusions was demonstrated following SSC implementation. 11 In a study conducted by Tarrago et al, they assessed the use of their pediatric intensive care unit (PICU) checklist and the effect on patient safety and cost.…”

“…Semel et al performed a decision analysis to determine if implementation of the SSC in the United States reduces costs within the hospital level. 18 Usage of the checklist was expected to cost the hospital roughly $40,859 USD. However, the net savings of the SSC was substantial.…”

“…In the base-case analysis, the implementation of the checklist was projected to save $103,829 USD in a hospital that performed 4000 non-cardiac surgeries annually (∼$25.96 USD per operation performed). 18 For every complication prevented, there was a recorded net saving of $8652 USD. As implementation costs for SSC comprise the majority of the expenses, savings could potentially be greater if analyzed for a prolonged study interval.…”

Handover checklist: testing a standardization process in an Italian hospital

“…Consequently, we can avoid the loss of information during shift change. 11 The principal purpose of the implementation of the handover is to reduce errors due to superficial and insufficient communication, so the patient’s complications, morbidity and mortality rate decrease. 12 …”