The perioperative handoff protocol: evaluating impacts on handoff defects and provider satisfaction in adult perianesthesia care units

Michelle A Petrovic; Hanan Aboumatar; Adam T Scholl; Randeep S Gill; Dina A Krenzischek; Melissa S Camp; Carolyn M Senger; Yi Deng; Tracy Y Chang; Yanjun Xie; Zahi R Jurdi; Elizabeth A Martinez

doi:10.1016/j.jclinane.2014.09.007

The perioperative handoff protocol: evaluating impacts on handoff defects and provider satisfaction in adult perianesthesia care units

J Clin Anesth. 2015 Mar;27(2):111-9. doi: 10.1016/j.jclinane.2014.09.007. Epub 2014 Dec 22.

Authors

Affiliations

¹ Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: rpetrov@jhmi.edu.
² Department of Medicine, Education and Research Associate, Armstrong Institute for Safety and Quality, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
³ Orlando, FL, USA.
⁴ The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁵ The Johns Hopkins Hospital, Baltimore, MD, USA.
⁶ Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁷ The Johns Hopkins University, Baltimore, MD, USA.
⁸ Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.

PMID: 25541368
DOI: 10.1016/j.jclinane.2014.09.007

Abstract

Study objective: To evaluate a new perioperative handoff protocol in the adult perianesthesia care units (PACUs).

Design: Prospective, unblinded cross-sectional study.

Setting: Perianesthesia care unit in a tertiary care facility serving 55,000 patients annually.

Patients: One hundred three surgery patients.

Interventions: During a 4-week preintervention phase, 53 perioperative handoffs were observed, and data were collected daily by a trained observer. Educational sessions were conducted to train perioperative practitioners on the new protocol. Two weeks after implementation, 50 consecutive handoffs were observed, and practitioners were surveyed with the same methodology as in the preintervention phase.

Measurements: Type of information shared, type and duration of procedure, total duration of handoff, number and type of providers at the bedside, number of report interruptions, environmental distractions, and any other disruptive events. Observers also tracked technical/equipment problems to include malfunctioning or compromised operation of medical equipment, such as the cardiac monitor, transducer, oxygen tank, and pulse oximeter.

Main results: A total of 103 handoffs were observed (53 preintervention and 50 postintervention). The mean number of defects per handoff decreased from 9.92 to 3.68 (P < .01). The mean number of missed information items from the surgery report decreased from 7.57 to 1.2 items per handoff and from 2.02 to 0.94 (P < .01) for the anesthesia report. Technical defects reported by unit nurses decreased from 0.34 to 0.10 (P = .04). Verbal reports delivered by surgeons increased from 21.2% to 83.3%. Although the mean duration of handoffs increased by 2 minutes (P = .01), the average time from patient arrival at PACU to handoff start was reduced by 1.5 minutes (P = .01). Satisfaction with the handoff improved significantly among PACU nurses.

Conclusions: The perioperative handoff protocol implementation was associated with improved information sharing and reduced handoff defects.

Keywords: Handoffs; Handovers; PACU; Perioperative; Transfers; Transitions.

Publication types

Evaluation Study

MeSH terms

Clinical Protocols
Communication
Cross-Sectional Studies
Humans
Interprofessional Relations
Maryland
Medical Errors / prevention & control*
Operating Rooms / organization & administration
Operating Rooms / standards*
Patient Care Team / organization & administration
Patient Care Team / standards
Patient Handoff / organization & administration
Patient Handoff / standards*
Patient Transfer / organization & administration
Patient Transfer / standards
Perioperative Care / standards*
Personal Satisfaction
Quality Improvement
Tertiary Care Centers / standards