Our February 14, 2012 Patient Safety Tip of the Week “Handoffs – More Than Battle of the Mnemonics” discussed several handoff tools and corresponding mnemonics which may be very helpful in your handoffs. The key message is that you need to implement tools that address the needs of each particular type of handoff that occurs in your organization. Though using a structured communication format or tool is important, the exact tool or format needed will vary by the nature of the handoff so “one size does not fit all”.
Particularly in the perioperative setting, the nature of handoffs is often very different from the resident-to-resident or nurse-to-nurse handoffs done on a medical unit.
We highlighted the AORN toolkit in our December 2011 What’s New in the Patient Safety World column “AORN Perioperative Handoff Toolkit” and several abstracts (Greenberg 2012) presented at the 2011 American Society of Anesthesiologists annual meeting dealt with perioperative handoffs/handovers.
But the folks at Johns Hopkins have taken the perioperative handoff to a new level (Petrovic 2012a). Most of the handoffs we have talked about in our prior columns have been handoffs either between like healthcare workers (eg. resident-to-resident, nurse-to-nurse, etc.) or between individual healthcare workers (eg. nurse-to-physician). The handoff process developed at Hopkins is a true multidisciplinary and interdisciplinary handoff. It was designed for transfers of patients from OR to PACU or PACU to ICU, etc. They first developed it and piloted it for patients destined for their cardiac-surgical ICU (CSICU) from the OR. It consists of a protocol and series of checklists. The protocol has 5 steps and takes place with the entire team in the patient room. The first step involves identifying the patient and introducing all members of the team. Step 2 involves “transfer of technology” (monitors, lines, etc.). Subsequent steps are checklist-guided handoffs by the surgeon, anesthesiologist, and OR nurse. Each of the latter 3 handoffs concludes with a statement of “anticipatory guidance” by the presenter, stating what he/she is most concerned about regarding the patient. Plenty of time is provided for members of the receiving team to ask questions and clarify items. The handoff formally concludes with an announcement “the handoff is now complete”. The article includes copies of the checklists and protocol and delineates the steps you need to go through to implement the protocol. The authors also have prepared a multimedia toolkit for those who want to implement the protocol at their institutions.
In a companion paper, they also have published some outcome measures from that protocol and process (Petrovic 2012b). After the protocol's implementation, the presence of all handoff core team members at the bedside increased from 0% at baseline to 68%, the percentage of missed information in the surgery report decreased from 26% to 16% , and handoff satisfaction scores among intensive care unit (ICU) nurses increased from 61% to 81%. On average, the duration of handoff increased by 1 minute.
This is really nice work. Do yourselves a favor and borrow from all the hard work they have done to develop this protocol and adapt it for your own needs.
Greenberg SB, Murphy GS, Vender JS. Scientific Papers Address Patient Safety. Patient Handover Communication. APSF Newsletter 2012; 26(3): 57 Winter 2012
Petrovic MA, Martinez
EA, Aboumatar H. Implementing a
Perioperative Handoff Tool to Improve Postprocedural Patient Transfers. Joint
Commission Journal on Quality and Patient Safety 2012; 38(3): 135-4AP(-130)
Petrovic MA, Aboumatar H , Baumgartner WA. Pilot Implementation of a Perioperative Protocol to Guide Operating Room–to–Intensive Care Unit Patient Handoffs. J Cardiothorac Vasc Anesth 2012; 26(1): 11-16