K. Sheppard1,4, K. E. Anthony1,4, A. Kubanda4, D. C. Salley4, C. H. Bryndzia3,4, R. R. Jain2,4, N. Wadwha2,4, K. P. Lally1,4, K. Tsao1,4, A. L. Kawaguchi1,4 1McGovern Medical School at UTHealth,Department Of Pediatric Surgery,Houston, TX, USA 2McGovern Medical School at UTHealth,Department Of Anesthesia,Houston, TX, USA 3McGovern Medical School at UTHealth,Department Of Pediatrics,Houston, TX, USA 4Children’s Memorial Hermann Hospital,Houston, TX, USA
Introduction: Medical errors are one of the leading causes of death in the United States and lapses in communication during patient handoffs have been identified as a significant contributor to medicals errors nationwide. We hypothesized that a scripted, standardized handoff protocol for all pediatric surgical patients transferred from the operating room to an intensive care unit will improve team member presence, information exchange, and communication.
Methods: A three-staged pre/post intervention observational study was conducted for the handoffs of pediatric patients from the operating room (OR) to the neonatal (NICU) and pediatric (PICU) intensive care units. The pre-intervention group (Group A) did not have a standardized handoff process. The first post-intervention group (Group B) used a standardized handwritten handoff form, while the second post-intervention group (Group C) used a standardized handoff process that included scripted questions developed by a multidisciplinary team of physicians. Team member presence at handoff, length of the handoff, number of distractions, and the transfer of essential patient and procedural information were measured through direct observation.
Results: Direct observation was done for 24, 36, and 45 handoffs in groups A, B, and C respectively. While the anesthesia team was nearly always present at the handoffs (96, 100, 100%), the surgical (4, 64, 73%) and ICU (38, 86,100%) teams vastly improved their attendance at handoffs. The time required for handoffs did not change significantly in the three groups (3.1 ± 2.8, 4.1 ± 3.0, and 3.5 ± 1.9 minutes, respectively). Patient care distractions during handoffs decreased over the three intervention periods (54%, 22%, and 11% of handoffs, respectively). The transfer of essential patient and procedural information improved with each intervention for the surgical teams (see chart). Anesthesiologists had stable reporting of airway concerns and opioid administration (88, 94, 88% and 87, 97, 95% for groups A, B, and C, respectively). Anesthesiologists showed modest improvements in relaying information about opioid and paralytic administration and dosage (50, 58, 75%, and 58, 86, 95% for groups A, B, and C, respectively). Antibiotic name and dosage were improved, but still missed almost half of the time (21, 44, 59% and 21, 36, 45% for groups A, B, and C, respectively).
Conclusion: Implementation of a scripted, rather than a written, standardized handoff process improved team member presence, decreased distractions, and further improved the transfer of information during handoffs. Future efforts will focus on improving adherence to the scripted handoff protocol and examining the relationship between handoffs and patient outcomes.
