Training in intraoperative handover and display of a checklist improve communication during transfer of care

Abstract

BACKGROUNDHandovers during anaesthesia are common, and failures in communication may lead to morbidity and mortality.OBJECTIVESWe hypothesised that intraoperative handover training and display of a checklist would improve communication during anaesthesia care transition in the operating room.DESIGNInterventional cohort study.SETTINGSingle-centre tertiary care university hospital.PARTICIPANTSA total of 204 random observations of handovers between anaesthesia providers (residents and nurse anaesthetists) over a 6-month period in 2016.INTERVENTIONTwo geographically different hospital sites were studied simultaneously (same observations, but no training/checklist at the control site): first a 2-week ‘baseline’ observation period; then handover training and display of checklists in each operating room (at the intervention site only) followed by an ‘immediate’ second and finally a third (3 months later) observation period.MAIN OUTCOME MEASURESA 22-item checklist was created by a modified DELPHI method and a checklist score calculated for each handover by adding the individual scores for each item as follows: −1, if error in communicating item; 0, unreported item; 0.5, if partly communicated item; 1, if correctly communicated item.RESULTSBefore training and display of the checklist, the scores in the interventional and the control groups were similar. There was no improvement in the control group's scores over the three observation periods. In the interventional group, the mean (95% confidence interval) score increased by 43% [baseline 7.6 (6.7 to 8.4) n = 42; ‘immediate’ 10.9 (9.4 to 12.4) n = 27, P < 0.001]. This improvement persisted at 3 months without an increase in the mean duration of handovers.CONCLUSIONIntraoperative handover training and display of a checklist in the operating room improved the checklist score for intraoperative transfer of care in anaesthesia.

Fatores que influenciam para transferência do cuidado intra-hospitalar efetiva: Revisão integrativa

“…Coorte; Prospectivo ou etiologia-N2 Jullia et al, 2017 Antes do treinamento e com a implementação de uma lista, as pontuações nos grupos intervenção e controle foram semelhantes. Com a intervenção a pontuação aumentou e a melhora persistiu por meses e sem aumento da duração das transferências.…”

Critical Appraisal of Anesthesiology Educational Research for 2017

“…Jullia M, Tronet A, Fraumar F, et al Training in intraoperative handover and display of a checklist improve communication during transfer of care: an interventional cohort study of anaesthesia residents and nurse anaesthetists. Eur J Anaesthesiol, 2017, 34:471 [9].…”

Systematic Review of Intraoperative Anesthesia Handoffs and Handoff Tools

“…10,20,26 Agarwala et al 10 reported that checklist adoption and use increased from 60% to 74% of intraoperative handoffs at 8 months after initial implementation. Similarly, Jullia et al 20 noted that the improvements in information scores persisted at 3 months postimplementation; however, other measures such as mean handoff duration and handoff documentation decreased at 3 months. Finally, Canale 26 reported that their checklist was integrated into the AIM system and was standardized into routine intraoperative handoff practice and presented at orientations for new clinicians.…”

“…For example, Agarwala et al 10 described improvements with regard to discussion of intraoperative medications and fluid balance and improved item recall with their checklist. With handoff training and a 22-item checklist, Jullia et al 20 reported that the mean information transfer scores improved by 43% in the intervention group. Similarly, Lee et al 28 reported that information items spontaneously relayed increased from 54% to 98% with an electronic handover checklist and tutorial.…”