Often Overlooked Problems with Handoffs

Evans, Adam S.; Yee, May Sann; Hogue, Charles W.

doi:10.1213/ane.0000000000000075

Cited by 9 publications

(2 citation statements)

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“…3 However, while intraoperative and postoperative handoffs are a critical component of anesthesiologists' practice, they have received far less attention in literature and reform than intensive care unit handoffs. 4,5 Many anesthesia providers agree that the current handoff protocol at their institution is insufficient and that the standardization of this process would improve patient care. 6,7 The highrisk handoff presents an opportunity to evaluate patient care practices and reduce adverse events.…”

Section: Manuscript Introductionmentioning

confidence: 99%

An Evaluation of CA-1 Residents’ Adherence to a Standardized Handoff Checklist

Heck

Huges

Konia

2017

JEPM

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Background: Poor-quality handoffs are a significant cause of preventable medical errors and adverse events. Handoff checklists improve handoffs but adherence to these tools is often inconsistent. In our study we aimed to investigate the effects of simulated handoff workshop and clinical instruction on resident handoff quality.Methods: A three-week pre-education intervention observation period of handoffs was conducted to assess the deficits, variability, and common practice in handoffs at the University of Minnesota Fairview Hospital. An institution specific handoff tool was then created by expert anesthesiologists at the University of Minnesota. A prospective observational assessment was then performed one year later to evaluate CA-1's adherence to the content of a standardized handoff checklist in the intraoperative and post-anesthesia care unit environment after exposure to current educational techniques.Results: With introduction of a handoff checklist tool, CA-1 residents included 70.70% (±0.11%) of handoff checklist information in their handoffs during the pre-workshop phase. Following a 2-hour simulated workshop on standardized handoffs, CA-1 residents still only included 70.00% (±0.02%) of handoff checklist information in their handoffs. CA-1 residents included 43.50% (±0.12%) of handoff checklist information in their handoffs at 6 months following the workshop. A one-way analysis of variance revealed a significant difference between the groups F(4, 135) = 18.83, p<0.05. Conclusions:The current method of education for handoffs does not ensure resident adherence to a standardized handoff technique. We propose that the inclusion of a written or electronic handoff checklist should be enforced and refresher courses should be administered early and frequently.

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Section: Manuscript Introductionmentioning

confidence: 99%

An Evaluation of CA-1 Residents’ Adherence to a Standardized Handoff Checklist

Heck

Huges

Konia

2017

JEPM

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“…There are multiple surgical settings with demonstrated inadequate handoff practices: intraoperative handoffs between anesthesia providers, [ 17 , 18 ] handoffs in the post-anesthesia care unit, [ 19 ] handoffs from the ICU to the OR, [ 20 ] and those from the OR to the ICU [ 5 , 7 – 12 ]. We chose to study OR-to-ICU handoffs because the evidence base supporting handoff standardization is more established for these handoffs than for the others mentioned.…”

Section: Introductionmentioning

confidence: 99%

Handoffs and transitions in critical care (HATRICC): protocol for a mixed methods study of operating room to intensive care unit handoffs

et al. 2014

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BackgroundOperating room to intensive care unit handoffs are high-risk events for critically ill patients. Studies in selected patient populations show that standardizing operating room to intensive care unit handoffs improves information exchange and decreases errors. To adapt these findings to mixed surgical populations, we propose to study the implementation of a standardized operating room to intensive care unit handoff process in two intensive care units currently without an existing standard process.Methods/DesignThe Handoffs and Transitions in Critical Care (HATRICC) study is a hybrid effectiveness- implementation trial of operating room to intensive care unit handoffs. We will use mixed methods to conduct a needs assessment of the current handoff process, adapt published handoff processes, and implement a new standardized handoff process in two academic intensive care units. Needs assessment: We will use non-participant observation to observe the current handoff process. Focus groups, interviews, and surveys of clinicians will elicit participants’ impressions about the current process. Adaptation and implementation: We will adapt published standardized handoff processes using the needs assessment findings. We will use small group simulation to test the new process’ feasibility. After simulation, we will incorporate the new handoff process into the clinical work of all providers in the study units. Evaluation: Using the same methods employed in the needs assessment phase, we will evaluate use of the new handoff process. Data analysis: The primary effectiveness outcome is the number of information omissions per handoff episode as compared to the pre-intervention period. Additional intervention outcomes include patient intensive care unit length of stay and intensive care unit mortality. The primary implementation outcome is acceptability of the new process. Additional implementation outcomes include feasibility, fidelity and sustainability.DiscussionThe HATRICC study will examine the effectiveness and implementation of a standardized operating room to intensive care unit handoff process. Findings from this study have the potential to improve healthcare communication and outcomes for critically ill patients.Trial registrationClinicalTrials.gov identifier: NCT02267174. Date of registration October 16, 2014.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2482-14-96) contains supplementary material, which is available to authorized users.

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