Implementation of a Standardized Handoff from the Operating Room to Pediatric Intensive Care Unit: A Quality Improvement Project
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Introduction: Patient handoffs from the operating room (OR) to the pediatric intensive care unit (PICU) is a multidisciplinary opportunity for miscommunication, error, and compromised patient safety. A quality improvement initiative was used to revise the current process and to create a streamlined standardized process. Population/Setting: Direct surgical admissions were observed from the OR to PICU at Children’s Nebraska. The target population were scheduled operations from general surgery, neurosurgery, orthopedics, and urology. Methods: In this before and after quality improvement project, a team of key stakeholders revised and developed a new handoff tool with a formalized process (direct surgeon post-op needs, hard stops for handoff to continue) to address identified pitfalls from a feedback survey (lack of co-signing drips with anesthesia, lack of visualization of patient drains/dressing, and no introductions by primary members). Data was collected using a standardized audit form on patient handoff information. Outcome metrics were measured both before and after the implementation of the new handoff tool. Results: 40 handoffs were directly observed (10 pre and 30 post intervention) during a 6-week timeframe. The predominant surgical type was neurosurgery. 5 out of 6 effects that were measured were statistically significant. The total duration of handoff was not statistically significant (using student t-test) with an increase in handoff time from 6.65 minutes to 5.7 minutes. Conclusion: Standardization of a handoff tool improved communication and decreased patient error.
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