Abstract
Objective: To determine if a standardized handover protocol from the operating room to the pediatric cardiac intensive care unit would be associated with an objective improvement in communication between care teams. In addition, if the protocol would be associated with improved subjective assessment with handoff, as well as provider satisfaction with the process.Methods: In phase 1, an assessment of 20 patient handovers from the cardiac operating room to the pediatric cardiac intensive care unit at Kravis Children’s Hospital was obtained by direct observation. A checklist of 23 key elements of patient transfer recorded patient identification, procedure information, anesthesia details, patient status and the duration of handoff. Later a survey was created to evaluate care team provider’s assessment of the information transferred during handoff, and their satisfaction with the process. Next a multidisciplinary team developed a 4 step standardized handover protocol. In phase 2, another 20 patient handovers were observed, and the provider survey was repeated.Measurements and Main Results: A total of 40 observations of patient handover were performed during the study. In phase 1, 69.3% of key handoff elements were transferred as compared to 81.3% in phase 2 (p = 0.003). The duration of the handoff was not significantly different between phases (7.85 min vs. 8.35 min; p = 0.69). There was a significant improvement in provider assessment of information transfer (6.58 vs. 7.58 mean modified Likert score; p = 0.003). There was a non-significant trend towards increased provider satisfaction with the handover process (6.26 vs. 6.85 mean modified Likert score; p = 0.33).Conclusions: In this study, a standardized handoff protocol was associated with objective and subjective improvements in communication between care teams without increasing the duration of handoff.
Highlights
The transfer of care between providers is a vulnerable time for critically ill children, especially those who have undergone cardiac surgery
To determine if a standardized handover protocol from the operating room to the pediatric cardiac intensive care unit would be associated with an objective improvement in communication between care teams
Care team providers were asked to rate their personal satisfaction with the handover process as it relates to understanding the information transferred, ability to perform their specific roles, and absence of distractions during patient handoff
Summary
The transfer of care between providers is a vulnerable time for critically ill children, especially those who have undergone cardiac surgery. This period is characterized by the presence of multiple providers, disruption in the monitoring of hemodynamics, transition of life sustaining devices and medications, and represents a time where clear communication is imperative. Previous studies have shown that inadequate communication during this crucial time has been associated with medical errors and adverse events[1,2,3,4]. Standardized handoff protocols from the Operating Room (OR) to the Cardiac Intensive Care Unit (CICU) have been shown to reduce communication errors and promote team efficiency[5,6,7]. In 2006, the Joint Commission recognized the importance of handoff communication in ensuring patient safety and designated improvement in patient handoff a National Patient Safety Goal[8].
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