Patient handover from surgery to intensive care: using Formula 1 pit‐stop and aviation models to improve safety and quality

Abstract

SummaryBackground: We aimed to improve the quality and safety of handover of patients from surgery to intensive care using the analogy of a Formula 1 pit stop and expertise from aviation. Methods: A prospective intervention study measured the change in performance before and after the implementation of a new handover protocol that was developed through detailed discussions with a Formula 1 racing team and aviation training captains. Fifty (23 before and 27 after) postsurgery patient handovers were observed. Technical errors and information omissions were measured using checklists, and teamwork was scored using a Likert scale. Duration of the handover was also measured. Results: The mean number of technical errors was reduced from 5.42 (95% CI ±1.24) to 3.15 (95% CI ±0.71), the mean number of information handover omissions was reduced from 2.09 (95% CI ±1.14) to 1.07 (95% CI ±0.55), and duration of handover was reduced from 10.8 min (95% CI ±1.6) to 9.4 min (95% CI ±1.29). Nine out of twenty-three (39%) precondition patients had more than one error in both technical and information handover prior to the new protocol, compared with three out of twnety-seven (11.5%) with the new handover. Regression analysis showed that the number of technical errors were significantly reduced with the new handover (t = )3.63, P < 0.001), and an interaction suggested that teamwork (t = 3.04, P = 0.004) had a different effect with the new handover protocol. Conclusions: The introduction of the new handover protocol lead to improvements in all aspects of the handover. Expertise from other industries can be extrapolated to improve patient safety, and in particular, areas of medicine involving the handover of patients or information.

Patient safety improvement interventions in children's surgery: A systematic review

“…Following the last search in January 2015, 20 studies [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] were identified for inclusion in the review (table 1).…”

“…The majority (70%) of included studies comprised peer-reviewed journal articles (n=14 [16][17][18][19][20][21]23,[25][26][27][28][33][34][35]) and the remainder represented peer-reviewed conference proceedings (published abstracts of oral presentations n=4 [22,[30][31][32] , posters n=2 [24,29]). …”

“…The majority (70%) of studies originated from US institutions (n=14 [16,17,20,22,23,25,27,28,[30][31][32][33][34][35]) with the remainder from the UK (n=2 [19,21]), Belgium (n=2 [26,29]), Canada (n=1 [18]) and Sweden (n=1 [24]). The inclusion criteria allowed studies published after 1980, however almost all (90%) were published within the last 5…”

“…years ( Critical care (n=9 [17][18][19][20][21][22]24,32]) was the most common setting for intervention deployment, followed by the operating room (n=5 [25,27,30,31,33]). …”

“…12 studies involved a single surgical specialty (CTS n=9 [16][17][18][19][20][21]24,26,32], ENT surgery n=3 [23,28,29]), 6 studies involved multiple children's surgical specialties within an institution and in 2 studies the surgical subspecialties involved were not clearly specified.…”