1069: LESSONS LEARNED USING A PERIOPERATIVE HANDOFF TOOL FOR PICU PATIENTS WITH AN OPEN MEDICAL STAFF

Abstract

Introduction: Standardized peri-operative hand-offs in the ICU lead to improved communication during patient transfer but implementation is not well described in an open medical staff model with many surgeons without trainees. Our goal was to implement a hand-off tool in this model and determine whether it improved staff satisfaction and communication in the PICU. Methods: A PI project was implemented in a PDSA framework. A workgroup was formed with representatives from PICU, anesthesia, and surgery, who created a hand-off tool and educated their teams. Its use was expected on all transfers from OR to PICU and PICU to OR for a 10-month period (Phase 1) and compliance was monitored. Pre- and post-implementation surveys were completed by nurses and physicians to assess level of agreement with statements on adequacy and communication in the hand-off process. After Phase 1, the staff were re-educated on the project and the tool was placed in the chart of eligible patients. Data was then collected over a 2-month period (Phase 2). Results: In Phase 1, there were 179 patients and 40 (22%) underwent the standardized hand-off. In Phase 2, 27 of 40 patients underwent the standardized hand-off (68%,p< 0.0001). Pre-surveys indicated over 90% of physicians and nurses felt that standardized hand-offs could improve patient safety and reduce team confusion. Post-implementation, nurse satisfaction with the hand-off process and communication improved from 24 to 65% and 8 to 57% respectively (p< 0.002). Physician satisfaction increased (50 vs 85%), but was not significant. Conclusions: Use of a peri-operative hand-off tool was associated with significantly greater feelings of hand-off adequacy and good communication among nurses. Although physicians felt that its use could improve safety and communication, it was difficult to get their compliance. This was due to many surgeons in private practice who did not have trainees to assist them. Identifying nursing and physician leaders, continually re-educating the process, and easing access to the hand-off tool are critical to successful implementation.