Optimizing postoperative handover to the intensive care unit at a tertiary centre
Abstract
Background:
Comprehensive handover of patients transferred from operating theatre to the intensive care unit is crucial in ensuring ongoing quality and safety of care. Handover in this setting poses unique challenges, yet few studies have considered or tested approaches to improve the process. A quality improvement project was undertaken to assess and improve the quality of information transfer during the handover of postoperative patients to the general intensive care unit at a tertiary centre.
Methods:
This quality improvement project considered all postoperative patients aged 18 years and over, using the plan-do-study-act (PDSA) approach, over a 3-month period in 2015. Baseline audit encompassing intraoperative details (allergies, grade of intubation, estimated blood loss, difficulties and complications) and the postoperative plan (analgesia, thromboprophylaxis, antibiotics and their proposed duration and nutrition) was undertaken to define the extent of the clinical problem. Changes were implemented over two cycles, centred around a novel checklist, and the transfer of information was re-audited after each cycle.
Results:
Baseline audit (n=30) revealed a need for improvement across all domains. In PDSA cycle 1, a novel checklist was introduced which led to global improvement across all areas with performance exceeding 70% in all but three out of nine domains (n=33). Engaging key stakeholders (PDSA cycle 2) resulted in overall improvement from baseline but decreased performance in just under half of domains in comparison to PDSA cycle 1 (n=31).
Conclusions:
Successful implementation of a series of simple interventions resulted in more effective handover of postoperative patients admitted to an intensive care unit. Sustained long-term improvement is a major challenge and can only be achieved with the global engagement of all staff and incorporation of changes into routine clinical practice.
References
- (2004) Incidents relating to the intra-hospital transfer of critically ill patients. Intensive Care Med 30(8): 1579–1585. https://doi.org/10.1007/s00134-004-2177-9 Google Scholar
- (2007) An experimental comparison of handover methods. Ann R Coll Surg Engl 89(3): 298–300. https://doi.org/10.1308/003588407X168352 Google Scholar
- (2013) Handovers From the OR to the ICU. Int Anesthesiol Clin 51(1): 43–61. https://doi.org/10.1097/AIA.0b013e31826f2b0e Google Scholar
- (2007) Patterns of communication breakdowns resulting in injury to surgical patients. J Am Coll Surg 204(4): 533–540. https://doi.org/10.1016/j.jamcollsurg.2007.01.010 Google Scholar
Health and Social Care Information Centre (2014) Hospital Episodes Statistics: Adult Critical in England 2012-13. http://content.digital.nhs.uk/catalogue/PUB13893/adul-crit-care-data-eng-apr-12-mar-13-rep.pdf (accessed 21 December 2016 ) Google Scholar- (2015) SQUIRE 2.0 (Standards for QUality Improvement Reporting Excellence): revised publication guidelines from a detailed consensus process. BMJ Qual Saf 25(12): 986–992. https://doi.org/10.1136/bmjqs-2015-004411 Google Scholar
- ;
Durham VA Patient Safety Center of Inquiry (2012) Can we make postoperative patient handovers safer? A systematic review of the literature. Anesth Analg 115(1): 102–115. https://doi.org/10.1213/ANE.0b013e318253af4b Google Scholar - (2008) Interprofessional handover and patient safety in anaesthesia: observational study of handovers in the recovery room. Br J Anaesth 101(3): 332–337. https://doi.org/10.1093/bja/aen168 Google Scholar
- ;
I-PASS Study Group (2014) Changes in medical errors after implementation of a handoff program. N Engl J Med 371(19): 1803–1812. https://doi.org/10.1056/NEJMsa1405556 Google Scholar - (2014) Systematic review of the application of the plan–do–study–act method to improve quality in healthcare. BMJ Qual Saf 23(4): 290–298. https://doi.org/10.1136/bmjqs-2013-001862 Google Scholar
The Royal College of Anaesthetists (2012) Raising the Standard: a compendium of audit recipes for continuous quality improvement in anaesthesia. www.rcoa.ac.uk/system/files/CSQ-ARB-2012_0.pdf (accessed 8 August 2016 ) Google ScholarThe Royal College of Surgeons of England (2007) Safe Handover: Guidance from the Working Time Directive working party. www.rcseng.ac.uk/library-and-publications/college-publications/docs/safe-handover/ (accessed 8 August 2016 ) Google Scholar- ;
American College of Critical Care Medicine (2004) Guidelines for the inter- and intrahospital transport of critically ill patients. Crit Care Med 32(1): 256–262. https://doi.org/10.1097/01.CCM.0000104917.39204.0A Google Scholar
