W. Butak1,2, C. Caswell1,2, D. Wilson2, A. Tatakis2, J. Gellings2, A. Farah2, R. Vala1,2, C. Jankowski2, D. Holena2 1Medical College Of Wisconsin, Medical School, Milwaukee, WI, USA 2Medical College Of Wisconsin, Division Of Trauma And Acute Care, Milwaukee, WI, USA
Introduction: The emergency department (ED) to operating room (OR) handoff for injured patients requiring operative intervention represent a critical junction in patient care. Numerous models and checklists have been developed to guide an effective handoff, but studying adherence is challenging secondary to a lack of available data sources. In 2024, our center initiated an intraoperative trauma video review program (IOTVR) as part of our quality improvement efforts, effectively providing a granular source of data to study this issue. We sought to describe variability in the timing and content of ED-to-OR handoff components being under-utilized, with the hypothesis that handoffs are shorter and less complete in hemodynamically unstable patients.
Methods: Using consecutive audiovisual recordings from June-July 2024 in a dedicated trauma operating room, ED-to-OR handoffs were assessed. We measured the occurrence and timing of elements of our existing institutional Trauma Anesthesia Checklist (TAC). We scored the occurrence of each handoff element based on whether it was clearly verbalized during the timeout and then calculated rates for each element. If elements were unknown by the team, said element was credited as having been verbalized. Linear regression was used to assess the relationship between handoff length and number of elements verbalized. We used Fisher’s exact test association of patient hypotension (systolic blood pressure <90mmHg) on completeness elements of ED-to-OR handoffs.
Results: We abstracted 43 cases over the 8-week study period. Hypotension was present in 12 (28%) cases. ED-to-OR handoffs were brief (median 36 (IQR 21-47 seconds). Utilization of all 14 hand-off elements was not completed in any of the cases assessed. The median number of handoff elements verbalized per case was 2 (IQR 1-3), with the history of present illness being the most common element verbalized (85% cases) followed by systolic blood pressure (35% cases). There was no relationship between the length of the handoff and the total number of elements verbalized (B = 4.2 (95% CI -0.7 – 0.9 seconds, p=0.09) and the presence of hypotension had no relationship with the verbalization of any element of the handoff.
Conclusion: The vast majority of ED-to-OR handoffs at our institution were incomplete regardless of patient hypotension, representing an opportunity to improve the quality of. IOTVR can be used to measure critical processes of care that occur in the setting of emergent surgical cases for trauma and identify important areas for improvement.