Board 142 - Program Innovations Abstract 3DiTeams Handover Initiative

Abstract

Introduction/Background Patient handovers after surgery to intensive care units (ICUs) are replete with communication and technical errors1-3 and studies highlight a relationship between handover quality and patient outcomes.4-6 The Duke Human Simulation and Patient Safety Center received an external educational grant to develop an immersive education environment that aims to improve communication and decrease preventable adverse events in operating room (OR) to neuro ICU handovers. This project used human-centered design (HCD) which incorporates user-centered feedback throughout the development process, thus allowing users to shape the design of the product and enhance its usability to intimately involve users in the refinement of their own handover.7,8 As part of the HCD process, focus groups were conducted with key members in the neuro ICU and OR. Methods Six focus groups were conducted with nurses, residents, fellows, attending physicians and nurse practitioners from the neuro ICU and with anesthesia providers and surgeons from the OR. These guided interviews lasted 30-60 minutes, were separated by role to promote open and honest communicationband utilized a standardized question set that addressed such topics as the responsibility for transmitting and receiving information, information documentation, leadership, problems with the current process and potential solutions. Data analysis was performed using conventional content analysis, a method generally used with a study design whose aim is to describe a phenomenon when existing theory on the topic is limited.to nine Analysis involved the systematic coding of text into categories that characterized and identified key concepts mentioned by the subjects. Focus group participants provided feedback on the current process and discussed the information transfer and available tools to facilitate it, as well as recommendations for improving the physical and information transfers and for developing new handover tools. Most concerning to unit members were missing information (e.g. patient history, patient name and pre-op exam status), multiple conversations, surgeons rushing and not providing enough information and nurses who were unwilling to receive report until the patient was settled in. The analysis revealed that many unit members feel a need for a standardized process, an easy to read, brief, informative summary sheet to be handed over with the patient and a tool to guide the verbal handover. Consistent teams, tasks defined by role and having all members of the team present during the information transfer were also desires expressed by unit members. Results: Conclusion Human-centered design was used to intimately involve educational program participants in designing tools to help improve handovers within their own units. Feedback from participants will be integrated into a multimodal educational program including a virtual environment for learning and practice, on-site clinical observations and technology-mediated coaching. The educational program aims to improve handovers and patient safety in critical care. The final product will be a modular program that can be expanded to address all types of handovers from shift-to-shift to more unit-specific processes.