What’s New in the Patient Safety World
March 2014
The “Reverse” Perioperative Handoff: ICU to OR
We’ve highlighted perioperative handoffs in several columns
(see our Patient Safety Tip of the Week for February 11, 2014 “Another
Perioperative Handoff Tool: SWITCH” and our What’s New in the Patient
Safety World columns for December 2011 “AORN
Perioperative Handoff Toolkit” and March 2012 “More
on Perioperative Handoffs”). But those have mostly dealt with handoffs of
patients coming out of the OR or PACU.
Now a new study highlights vulnerabilities in handoffs in the opposite direction: from the ICU to the operating room (Evans 2014). The authors cite several case vignettes of problems with patient care emanating from poor handoffs as patients go to the OR from the ICU. They note the inability of the patient to provide history in many cases (altered mental status, sedation, intubation, etc.) increases the need for a detailed clinician-to-clinician handoff.
They also note that most of the standardized handoff formats we’ve discussed in our many columns on handoffs (see list below) don’t work well for this “reverse” perioperative handoff. So they developed their own checklist for this type of handoff and this could be completed on paper or electronic format. This checklist includes not only those items you’d expect in a handoff (demographics, current illness, past medical history, medications, allergies, lab results, etc.) but also specifics about various lines and catheters, DNR status, hemodynamic trends, airway problems, ventilator settings, antibiotic regimens, infusions, cardiac implantable devices, etc.
The authors appropriately note that a mandatory verbal handoff still needs to take place. We’ve stressed on numerous occasions that the combination of written and verbal handoff almost always outperforms handoffs that only use either the written or verbal format. Again, we stress that performing the verbal handoff in a venue free of distractions and interruptions works best and that handoffs are “two-way” where adequate opportunity must be present for the recipient to ask questions and get clarifications.
Read about many other handoff issues (in both healthcare and other industries) in some of our previous columns:
May 15, 2007 “Communication, Hearback and Other Lessons from Aviation”
May 22, 2007 “More on TeamSTEPPS™”
August 28, 2007 “Lessons
Learned from Transportation Accidents”
December 11, 2007 “Communication…Communication…Communication”
February 26, 2008 “Nightmares….The Hospital at Night”
September 30, 2008 “Hot Topic: Handoffs”
November 18, 2008 “Ticket to Ride: Checklist, Form, or Decision Scorecard?”
December 2008 “Another Good Paper on Handoffs”.
June 30, 2009 “iSoBAR: Australian Clinical Handoffs/Handovers”
April 25, 2009 “Interruptions, Distractions, Inattention…Oops!”
April 13, 2010 “Update
on Handoffs”
July 12, 2011 “Psst!
Pass it on…How a kid’s game can mold good handoffs”
July 19, 2011 “Communication
Across Professions”
November 2011 “Restricted
Housestaff Work Hours and Patient Handoffs”
December 2011 “AORN
Perioperative Handoff Toolkit”
February 14, 2012 “Handoffs – More Than Battle of the Mnemonics”
March 2012 “More
on Perioperative Handoffs”
June 2012 “I-PASS
Results and Resources Now Available”
August 2012 “New
Joint Commission Tools for Improving Handoffs”
August 2012 “Review
of Postoperative Handoffs”
January 29, 2013 “A
Flurry of Activity on Handoffs”
December 10, 2013 “Better
Handoffs, Better Results”
February 11, 2014 “Another
Perioperative Handoff Tool: SWITCH”
References:
Evans AS, Yee M-S, Hogue CW. Often Overlooked Problems with Handoffs: From the Intensive Care Unit to the Operating Room. Anesthesia & Analgesia., POST AUTHOR CORRECTIONS, 9 January 2014
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