Evaluation of a Paper-Based Checklist versus an Electronic Handover Tool Based on the Situation Background Assessment Recommendation (SBAR) Concept in Patients after Surgery for Congenital Heart Disease.

Carolin Rehm,Sven Zenker,Ehrenfried Schindler,Alina Schenk,Nadine Strassberger-Nerschbach,Richard Zoller,Nicole Müller

doi:10.3390/jcm10245724

Abstract

(1) Background: we compare a new SBAR based electronic handover tool versus a paper-based checklist for handover in a pediatric intensive care unit (PICU). (2) Methods: this is a randomized, observational study of 40 electronic vs. 40 paper checklist handovers after pediatric cardiac surgery, with a 48 items checklist for comparison of reporting frequencies and notification of disturbances and noise. PICU staff satisfaction was evaluated by a 12-item questionnaire. (3) Results: in 14 out of 40 cases, there were problems with data processing (incomplete or no data processing). Some item groups (e.g., hemodynamics) were consistently reported at higher frequencies than other groups. Items not specifically asked for did not get reported. Some items, automatically processed in the SBAR handover page, did not get reported. Many handovers suffered a noisy and distracting atmosphere. There was no difference in staff satisfaction between the two handover approaches. Nurses were highly unsatisfied with the general approach by which the handover was performed. (4) Conclusions: human error appears to be a main factor for unreliable data processing. Software is still too complicated, and multitasking is a stressful and error prone event. Handover is a complex task with many factors required for a successful completion.

Highlights

Patient handovers, defined as: “the transfer of information and professional responsibility and accountability between individuals and teams,” are high-risk, error-prone patient care episodes [1,2]
Handover from operating room (OR) to pediatric intensive care unit (PICU) used to be performed with a paper-based checklist, which has been used for about ten years quite successfully
Since the hospital is on its way towards completely paperless processes, which, for anesthesia and intensive care units (ICU), are implemented primarily using an electronic patient data management system (PDMS)

Summary

Introduction

Patient handovers, defined as: “the transfer of information and professional responsibility and accountability between individuals and teams,” are high-risk, error-prone patient care episodes [1,2]. The transfer of patient information can be affected by poor communication and teamwork, unstable patients, interruptions, distractions, technical problems with pumps, ventilators or monitoring, inconsistent teams, and poor standardization [1,2,3]. Especially in pediatric cardiac intensive care units, have been investigated and show, after implementation of a standardized handover protocol, a reduction in errors, decrease in technical problems and improvement of team work and communication, increasing patient safety [6,8,9,10]. The implementation of a standardized handover protocol seems to be sustainable, with good handover results even after the post-intervention phase [11], and a team hand-off approach leads to less omission of information, improves efficiency, and increases staff satisfaction [12]. Other data, such as medication, fluids, lines, tubes, and others have to be chosen out of a menu and confirmed manually to get transferred into the record

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