A. Phillips1, V. Olshove1, S. Sheth1, E. Zahn1, C. Chrysostomou1, K. Catchpole1, B. L. Gewertz1 1Cedars-Sinai Medical Center,Surgery,Los Angeles, CA, USA
Introduction: The transfer of patients from the operating room to the intensive care unit is a critical time and requires the co-ordination of many personnel and devices as well as the accurate exchange of patient information. We used human factors analytic techniques to improve specific elements of handoffs (task design and sequencing, teamwork, communication and workspace). We measured the impact of the changed handoff protocol on disturbances in care ( “flow disruptions”, FD) and clinical outcomes. We hypothesis that compliance with an enriched handoff process (EHP) would improve efficiency and reduce disruptions in patient care.
Methods: In a prospective, interrupted time-series observational study in the Congenital Heart Intensive Care (CHPICU), Cardiothoracic Intensive Care, Neonatal Intensive Care, twenty-nine consecutive patients were studied in two distinct intervals: Group 1 patients (n=16) were admitted with a traditional handoff process while Group 2 patients (n=13) were cared for after the EHP was developed, and cared for in the CHPICU. Through direct observation, 5 categories of FD were assessed (organization, teamwork, patient factors, equipment, communication). In addition, 5 key clinical outcomes were evaluated 6 hrs after admission to the ICU (vital signs, bleeding, general condition, respiratory status and drugs).
Results: Time (minutes) to complete the handoff was less in Group 2 (23.5±7.5) compared to Group 1 (35±14.6, p<0.05). FD were reduced after implementation of the EHP (Group 1, 1.5±1.2 per patient, Group 2 0.8±1.2 per patient, p=0.12), with redution in FD due to personnel (31.3% to 15.4%), patient (12.5% to 7.7%), and equipment (43.8% to 38.5%). Communication FD were 12.5% in both groups. The incidence of all negative clinical outcomes per patient at 6 hrs post admission were reduced after implementation of the EHP, 0.9±0.8 to 0.2±0.4, p<0.05.
Conclusion: Developing a standardized and structured perioperative handoff process specific for each institution can improve care. The use of a enriched handoff process reduces the time to compete the hand-off, reduces flow distrubances, and leads to a reduction in negative clinical outcomes at 6 hours. Uniform compliance remains a challenge and merits continued attention, as well as equipement and communication flow disturbances during the hand-off.