Implementation of a standardized handoff protocol for post-operative admissions to the surgical intensive care unit

Mukhopadhyay, Dhriti; Wiggins-Dohlvik, Katie; Mrdutt, Mary M.; Hamaker, Jeffrey S.; Machen, G. Luke; Davis, Matthew L.; Regner, Justin L.; Smith, Randall W.; Ciceri, David; Shake, Jay G.

doi:10.1016/j.amjsurg.2017.08.005

Cited by 32 publications

(24 citation statements)

References 13 publications

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“…One study found that their handoff implementation was associated with greater participation among team members at handoff ( P < 0.001) and increased information sharing–related surgical procedures ( P < 0.05). 20 Another study supported the efficacy of a structure handover process between the operating room and intensive care unit, where the structured handover was associated with a significant decrease in both the number of process errors (6.1–2.8, P < 0.001) and information sharing errors 6 months after the intervention (5.2 per handover to 2.3 per handover, P < 0.001). 14 …”

Section: Resultsmentioning

confidence: 89%

Improving Team Performance and Patient Safety on the Job Through Team Training and Performance Support Tools: A Systematic Review

Costar

Hall

2020

J Patient Saf

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We learned that the success or failure of implementation and diffusion across a health system does not depend primarily on the attributes of the innovation or the characteristics of the individual adopter. Rather it is due to the multiple and complex interactions between the enablers and frontline behaviors that arise in particular healthcare contexts and settings. In every case, four particular enablers were critical to success: 1. Vision, strategy and leadership: Every case had a clear vision which described the desired future around which all stakeholders could align; a well-defined strategy to execute the vision; and strong, effective leadership to build support for the vision and deliver the change. 2. A specific organization, program or initiative to promote diffusion: A special purpose program, organization or network of organizations was created or already in place to provide the impetus, coordination , resources and structures that facilitated diffusion of the innovation. 3. Funding for research, development and diffusion: Funding was made available to develop, pilot, evaluate, and/or scale-up diffusions. Initial funding generally came from the government, non-government organizations (NGOs) and other donors, sometimes combined with in-kind support from multiple parties. 4. Communication channels and networks across healthcare, other industries and the public: Effective communication and linkages across stakeholders helped to ensure that all were working towards a common goal and sharing insights on what as working well or not so well. Based on the evidence from the case studies, we believe that priority should be given to cultivating these four critical enablers. The absence of any one could have negative repercussions for the scale and pace of the take-up of the innovation.

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Section: Resultsmentioning

confidence: 89%

Improving Team Performance and Patient Safety on the Job Through Team Training and Performance Support Tools: A Systematic Review

Costar

Hall

2020

J Patient Saf

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“…Serious adverse events occur mainly in the period of handoffs from operating room to the intensive care unit. Many hospitals have an own handoff protocol to minimize incomplete handoffs, and an essential factor of handoff protocols is intubation details [24]. Therefore, we focused on the endotracheal tube management immediately after the patient is admitted to the SICU rather than in the operating room.…”

Section: Discussionmentioning

confidence: 99%

Shallow nasal RAE tube depth after head and neck surgery: association with preoperative and intraoperative factors

Kim

Shin

et al. 2019

J Anesth

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Purpose To evaluate risk factors associated with improper postoperative nasal Ring-Adair-Elwyn (RAE) tube depth. Methods We retrospectively enrolled 133 adult patients who were admitted to the intensive care unit (ICU) with the nasal RAE tube after head and neck surgery. Postoperative chest radiography was performed to confirm nasal RAE tube depth immediately after the patient was admitted to the ICU. Proper tube depth was defined as the tube tip between 2 and 7 cm above the carina. The patients were divided into the proper-depth group (78 patients) and the improper-depth group (55 patients). Patients' characteristics were collected. The risk factors for improper postoperative tube depth were assessed using logistic regression analysis. Main results All patients who showed improper tube depth had a shallow tube depth (the tube tip > 7 cm above the carina). Multivariable analysis revealed that tall stature [odds ratio (OR) 1.16; 95% confidence interval (CI) 1.08-1.25; P < 0.001], prolonged anesthesia duration (OR 1.16; 95% CI 1.02-1.32; P = 0.026), and right-sided surgical field as compared to the left (OR 0.36; 95% CI 0.14-0.93; P = 0.034) or median field (OR 0.25; 95% CI 0.07-0.85; P = 0.027) were risk factors associated with postoperative shallow tube depth. Conclusions Tall stature, prolonged anesthesia duration, and right-sided surgical field were independent risk factors for postoperative shallow nasal RAE tube depth.

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“…9,11 However, based on our recent systematic review, we identified inconsistent evidence on effectiveness of current handoff tools has been inconsistent and mixed 12,13 coupled with limited intervention sustainability over time, 14 which can be partially attributed to current tool limitations. Primarily, postoperative handoff tools were (1) lacking support for interdisciplinary teamwork and anticipatory guidance during handoffs, (2) paper based 15,16 with few exceptions, [17][18][19][20][21] and 3focused on improving standardization of process-driven protocols 18 with limited support for supporting communication interactions and coordination needs of receiving teams. 22 To address these limitations, we conducted a user-centered study 23 to explore design requirements for an electronic health record (EHR)-integrated intervention to support effective, efficient, and interactive handoffs supporting interdisciplinary team workflows.…”

Section: Background and Significancementioning

confidence: 99%

Ascertaining Design Requirements for Postoperative Care Transition Interventions

2021

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Background Handoffs or care transitions from the operating room (OR) to intensive care unit (ICU) are fragmented and vulnerable to communication errors. Although protocols and checklists for standardization help reduce errors, such interventions suffer from limited sustainability. An unexplored aspect is the potential role of developing personalized postoperative transition interventions using artificial intelligence (AI)-generated risks. Objectives This study was aimed to (1) identify factors affecting sustainability of handoff standardization, (2) utilize a human-centered approach to develop design ideas and prototyping requirements for a sustainable handoff intervention, and (3) explore the potential role for AI risk assessment during handoffs. Methods We conducted four design workshops with 24 participants representing OR and ICU teams at a large medical academic center. Data collection phases were (1) open-ended questions, (2) closed card sorting of handoff information elements, and (3) scenario-based design ideation and prototyping for a handoff intervention. Data were analyzed using thematic analysis. Card sorts were further tallied to characterize handoff information elements as core, flexible, or unnecessary. Results Limited protocol awareness among clinicians and lack of an interdisciplinary electronic health record (EHR)-integrated handoff intervention prevented long-term sustainability of handoff standardization. Clinicians argued for a handoff intervention comprised of core elements (included for all patients) and flexible elements (tailored by patient condition and risks). They also identified unnecessary elements that could be omitted during handoffs. Similarities and differences in handoff intervention requirements among physicians and nurses were noted; in particular, clinicians expressed divergent views on the role of AI-generated postoperative risks. Conclusion Current postoperative handoff interventions focus largely on standardization of information transfer and handoff processes. Our design approach allowed us to visualize accurate models of user expectations for effective interdisciplinary communication. Insights from this study point toward EHR-integrated, “flexibly standardized” care transition interventions that can automatically generate a patient-centered summary and risk-based report.

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Implementation of a standardized handoff protocol for post-operative admissions to the surgical intensive care unit

Cited by 32 publications

References 13 publications

Improving Team Performance and Patient Safety on the Job Through Team Training and Performance Support Tools: A Systematic Review

Improving Team Performance and Patient Safety on the Job Through Team Training and Performance Support Tools: A Systematic Review

Shallow nasal RAE tube depth after head and neck surgery: association with preoperative and intraoperative factors

Ascertaining Design Requirements for Postoperative Care Transition Interventions

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