A Partially Structured Postoperative Handoff Protocol Improves Communication in 2 Mixed Surgical Intensive Care Units: Findings From the Handoffs and Transitions in Critical Care (HATRICC) Prospective Cohort Study
OBJECTIVE:To assess the effectiveness of standardizing operating room (OR) to intensive care unit (ICU) handoffs in a mixed surgical population. SUMMARY OF BACKGROUND DATA:Standardizing OR to ICU handoffs improves information transfer after cardiac surgery, but there is limited evidence in other sur...
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| Veröffentlicht in: | Annals of surgery 2020-03, Vol.271 (3), p.484-493 |
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| creator | Lane-Fall, Meghan B. Pascual, Jose L. Peifer, Hannah G. Di Taranti, Laura J. Collard, Meredith L. Jablonski, Juliane Gutsche, Jacob T. Halpern, Scott D. Barg, Frances K. Fleisher, Lee A. |
| description | OBJECTIVE:To assess the effectiveness of standardizing operating room (OR) to intensive care unit (ICU) handoffs in a mixed surgical population.
SUMMARY OF BACKGROUND DATA:Standardizing OR to ICU handoffs improves information transfer after cardiac surgery, but there is limited evidence in other surgical contexts.
METHODS:This prospective interventional cohort study (NCT02267174) was conducted in 2 surgical ICUs in 2 affiliated hospitals. From 2014 to 2016, we developed, implemented, and assessed the effectiveness of a new standardized handoff protocol requiring bedside clinician communication using an information template. The primary study outcome was number of information omissions out of 13 possible topics, recorded by trained observers. Data were analyzed using descriptive statistics, bivariate analyses, and multivariable regression.
RESULTS:We observed 165 patient transfers (68 pre-, 97 postintervention). Before standardization, observed handoffs had a mean 4.7 ± 2.9 information omissions each. After standardization, information omissions decreased 21.3% to 3.7 ± 1.9 (P = 0.023). In a pre-specified subanalysis, information omissions for new ICU patients decreased 36.2% from 4.7 ± 3.1 to 3.0 ± 1.6 (P = 0.008, interaction term P = 0.008). The decrement in information omissions was linearly associated with the number of protocol steps followed (P < 0.001). After controlling for patient stability, the intervention was still associated with reduced omissions. Handoff duration increased after standardization from 4.1 ± 3.3 to 8.0 ± 3.9 minutes (P < 0.001). ICU mortality and length of stay did not change postimplementation.
CONCLUSION:Standardizing OR to ICU handoffs significantly improved information exchange in 2 mixed surgical ICUs, with a concomitant increase in handoff duration. Additional research is needed to identify barriers to and facilitators of handoff protocol adherence. |
| doi_str_mv | 10.1097/SLA.0000000000003137 |
| format | Article |
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SUMMARY OF BACKGROUND DATA:Standardizing OR to ICU handoffs improves information transfer after cardiac surgery, but there is limited evidence in other surgical contexts.
METHODS:This prospective interventional cohort study (NCT02267174) was conducted in 2 surgical ICUs in 2 affiliated hospitals. From 2014 to 2016, we developed, implemented, and assessed the effectiveness of a new standardized handoff protocol requiring bedside clinician communication using an information template. The primary study outcome was number of information omissions out of 13 possible topics, recorded by trained observers. Data were analyzed using descriptive statistics, bivariate analyses, and multivariable regression.
RESULTS:We observed 165 patient transfers (68 pre-, 97 postintervention). Before standardization, observed handoffs had a mean 4.7 ± 2.9 information omissions each. After standardization, information omissions decreased 21.3% to 3.7 ± 1.9 (P = 0.023). In a pre-specified subanalysis, information omissions for new ICU patients decreased 36.2% from 4.7 ± 3.1 to 3.0 ± 1.6 (P = 0.008, interaction term P = 0.008). The decrement in information omissions was linearly associated with the number of protocol steps followed (P < 0.001). After controlling for patient stability, the intervention was still associated with reduced omissions. Handoff duration increased after standardization from 4.1 ± 3.3 to 8.0 ± 3.9 minutes (P < 0.001). ICU mortality and length of stay did not change postimplementation.
CONCLUSION:Standardizing OR to ICU handoffs significantly improved information exchange in 2 mixed surgical ICUs, with a concomitant increase in handoff duration. Additional research is needed to identify barriers to and facilitators of handoff protocol adherence.</description><identifier>ISSN: 0003-4932</identifier><identifier>EISSN: 1528-1140</identifier><identifier>DOI: 10.1097/SLA.0000000000003137</identifier><identifier>PMID: 30499797</identifier><language>eng</language><publisher>United States: Wolters Kluwer Health, Inc. All rights reserved</publisher><subject>Critical Care - standards ; Grounded Theory ; Humans ; Intensive Care Units - standards ; Interdisciplinary Communication ; Operating Rooms - standards ; Patient Handoff - standards ; Patient Transfer - standards ; Pennsylvania ; Postoperative Period ; Prospective Studies ; Qualitative Research ; Surveys and Questionnaires</subject><ispartof>Annals of surgery, 2020-03, Vol.271 (3), p.484-493</ispartof><rights>Wolters Kluwer Health, Inc. All rights reserved.</rights><rights>Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c3507-49cae0104facdcb6210f19e36524e97ab771ba5a555e9b1901ece4098abc61293</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27923,27924</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30499797$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lane-Fall, Meghan B.</creatorcontrib><creatorcontrib>Pascual, Jose L.</creatorcontrib><creatorcontrib>Peifer, Hannah G.</creatorcontrib><creatorcontrib>Di Taranti, Laura J.</creatorcontrib><creatorcontrib>Collard, Meredith L.</creatorcontrib><creatorcontrib>Jablonski, Juliane</creatorcontrib><creatorcontrib>Gutsche, Jacob T.</creatorcontrib><creatorcontrib>Halpern, Scott D.</creatorcontrib><creatorcontrib>Barg, Frances K.</creatorcontrib><creatorcontrib>Fleisher, Lee A.</creatorcontrib><creatorcontrib>HATRICC study team (Kimberly Allen, BSN, RN; Mark Barry, MD; Sruthi Buddai, BA; Tyler Chavez, BA; Mahrukh Choudhary, BA; Della George; Megan Linehan, DO; Enrique Torres Hernandez; Jerome Watts, BA</creatorcontrib><title>A Partially Structured Postoperative Handoff Protocol Improves Communication in 2 Mixed Surgical Intensive Care Units: Findings From the Handoffs and Transitions in Critical Care (HATRICC) Prospective Cohort Study</title><title>Annals of surgery</title><addtitle>Ann Surg</addtitle><description>OBJECTIVE:To assess the effectiveness of standardizing operating room (OR) to intensive care unit (ICU) handoffs in a mixed surgical population.
SUMMARY OF BACKGROUND DATA:Standardizing OR to ICU handoffs improves information transfer after cardiac surgery, but there is limited evidence in other surgical contexts.
METHODS:This prospective interventional cohort study (NCT02267174) was conducted in 2 surgical ICUs in 2 affiliated hospitals. From 2014 to 2016, we developed, implemented, and assessed the effectiveness of a new standardized handoff protocol requiring bedside clinician communication using an information template. The primary study outcome was number of information omissions out of 13 possible topics, recorded by trained observers. Data were analyzed using descriptive statistics, bivariate analyses, and multivariable regression.
RESULTS:We observed 165 patient transfers (68 pre-, 97 postintervention). Before standardization, observed handoffs had a mean 4.7 ± 2.9 information omissions each. After standardization, information omissions decreased 21.3% to 3.7 ± 1.9 (P = 0.023). In a pre-specified subanalysis, information omissions for new ICU patients decreased 36.2% from 4.7 ± 3.1 to 3.0 ± 1.6 (P = 0.008, interaction term P = 0.008). The decrement in information omissions was linearly associated with the number of protocol steps followed (P < 0.001). After controlling for patient stability, the intervention was still associated with reduced omissions. Handoff duration increased after standardization from 4.1 ± 3.3 to 8.0 ± 3.9 minutes (P < 0.001). ICU mortality and length of stay did not change postimplementation.
CONCLUSION:Standardizing OR to ICU handoffs significantly improved information exchange in 2 mixed surgical ICUs, with a concomitant increase in handoff duration. Additional research is needed to identify barriers to and facilitators of handoff protocol adherence.</description><subject>Critical Care - standards</subject><subject>Grounded Theory</subject><subject>Humans</subject><subject>Intensive Care Units - standards</subject><subject>Interdisciplinary Communication</subject><subject>Operating Rooms - standards</subject><subject>Patient Handoff - standards</subject><subject>Patient Transfer - standards</subject><subject>Pennsylvania</subject><subject>Postoperative Period</subject><subject>Prospective Studies</subject><subject>Qualitative Research</subject><subject>Surveys and Questionnaires</subject><issn>0003-4932</issn><issn>1528-1140</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFktFu0zAUhi0EYmXwBgj5clxk2I7TxNxVEV0rFVHR7jpynJPVkNjFdrb1QXkfnHZMaBfDN8c--v_vHPsYofeUXFIi8k-b1eyS_LNSmuYv0IRmrEgo5eQlmozZhIuUnaE33v8ghPKC5K_RWUq4ELnIJ-j3DK-lC1p23QFvghtUGBw0eG19sHtwMuhbwAtpGtu2eO1ssMp2eNnvnb0Fj0vb94PRKuqswdpghr_q-wjYDO4mpqPUBDB-pJTSAb42OvjPeK5No82Nx3Nnexx2jzU8jhFvnYyekelHaOnifoQdEReL2fb7siw_jv34Pahjj6XdWRfiHYbm8Ba9amXn4d1DPEfX8y_bcpGsvl0ty9kqUWlG8vg0SgKhhLdSNaqeMkpaKiCdZoyDyGWd57SWmcyyDERNBaGggBNRyFpNKRPpObo4ceNr_BrAh6rXXkHXSQN28BWjPNI54zxK-UmqYs_eQVvtne6lO1SUVONAqzjQ6ulAo-3DQ4Wh7qF5NP2dYBQUJ8Gd7QI4_7Mb7sBVO5Bd2P2PzZ-xHnXTrEgYYdEQDwkZf1D6B2AMv0s</recordid><startdate>20200301</startdate><enddate>20200301</enddate><creator>Lane-Fall, Meghan B.</creator><creator>Pascual, Jose L.</creator><creator>Peifer, Hannah G.</creator><creator>Di Taranti, Laura J.</creator><creator>Collard, Meredith L.</creator><creator>Jablonski, Juliane</creator><creator>Gutsche, Jacob T.</creator><creator>Halpern, Scott D.</creator><creator>Barg, Frances K.</creator><creator>Fleisher, Lee A.</creator><general>Wolters Kluwer Health, Inc. All rights reserved</general><general>Copyright Wolters Kluwer Health, Inc. All rights reserved</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20200301</creationdate><title>A Partially Structured Postoperative Handoff Protocol Improves Communication in 2 Mixed Surgical Intensive Care Units: Findings From the Handoffs and Transitions in Critical Care (HATRICC) Prospective Cohort Study</title><author>Lane-Fall, Meghan B. ; Pascual, Jose L. ; Peifer, Hannah G. ; Di Taranti, Laura J. ; Collard, Meredith L. ; Jablonski, Juliane ; Gutsche, Jacob T. ; Halpern, Scott D. ; Barg, Frances K. ; Fleisher, Lee A.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3507-49cae0104facdcb6210f19e36524e97ab771ba5a555e9b1901ece4098abc61293</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Critical Care - standards</topic><topic>Grounded Theory</topic><topic>Humans</topic><topic>Intensive Care Units - standards</topic><topic>Interdisciplinary Communication</topic><topic>Operating Rooms - standards</topic><topic>Patient Handoff - standards</topic><topic>Patient Transfer - standards</topic><topic>Pennsylvania</topic><topic>Postoperative Period</topic><topic>Prospective Studies</topic><topic>Qualitative Research</topic><topic>Surveys and Questionnaires</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lane-Fall, Meghan B.</creatorcontrib><creatorcontrib>Pascual, Jose L.</creatorcontrib><creatorcontrib>Peifer, Hannah G.</creatorcontrib><creatorcontrib>Di Taranti, Laura J.</creatorcontrib><creatorcontrib>Collard, Meredith L.</creatorcontrib><creatorcontrib>Jablonski, Juliane</creatorcontrib><creatorcontrib>Gutsche, Jacob T.</creatorcontrib><creatorcontrib>Halpern, Scott D.</creatorcontrib><creatorcontrib>Barg, Frances K.</creatorcontrib><creatorcontrib>Fleisher, Lee A.</creatorcontrib><creatorcontrib>HATRICC study team (Kimberly Allen, BSN, RN; Mark Barry, MD; Sruthi Buddai, BA; Tyler Chavez, BA; Mahrukh Choudhary, BA; Della George; Megan Linehan, DO; Enrique Torres Hernandez; Jerome Watts, BA</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Annals of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lane-Fall, Meghan B.</au><au>Pascual, Jose L.</au><au>Peifer, Hannah G.</au><au>Di Taranti, Laura J.</au><au>Collard, Meredith L.</au><au>Jablonski, Juliane</au><au>Gutsche, Jacob T.</au><au>Halpern, Scott D.</au><au>Barg, Frances K.</au><au>Fleisher, Lee A.</au><aucorp>HATRICC study team (Kimberly Allen, BSN, RN; Mark Barry, MD; Sruthi Buddai, BA; Tyler Chavez, BA; Mahrukh Choudhary, BA; Della George; Megan Linehan, DO; Enrique Torres Hernandez; Jerome Watts, BA</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A Partially Structured Postoperative Handoff Protocol Improves Communication in 2 Mixed Surgical Intensive Care Units: Findings From the Handoffs and Transitions in Critical Care (HATRICC) Prospective Cohort Study</atitle><jtitle>Annals of surgery</jtitle><addtitle>Ann Surg</addtitle><date>2020-03-01</date><risdate>2020</risdate><volume>271</volume><issue>3</issue><spage>484</spage><epage>493</epage><pages>484-493</pages><issn>0003-4932</issn><eissn>1528-1140</eissn><abstract>OBJECTIVE:To assess the effectiveness of standardizing operating room (OR) to intensive care unit (ICU) handoffs in a mixed surgical population.
SUMMARY OF BACKGROUND DATA:Standardizing OR to ICU handoffs improves information transfer after cardiac surgery, but there is limited evidence in other surgical contexts.
METHODS:This prospective interventional cohort study (NCT02267174) was conducted in 2 surgical ICUs in 2 affiliated hospitals. From 2014 to 2016, we developed, implemented, and assessed the effectiveness of a new standardized handoff protocol requiring bedside clinician communication using an information template. The primary study outcome was number of information omissions out of 13 possible topics, recorded by trained observers. Data were analyzed using descriptive statistics, bivariate analyses, and multivariable regression.
RESULTS:We observed 165 patient transfers (68 pre-, 97 postintervention). Before standardization, observed handoffs had a mean 4.7 ± 2.9 information omissions each. After standardization, information omissions decreased 21.3% to 3.7 ± 1.9 (P = 0.023). In a pre-specified subanalysis, information omissions for new ICU patients decreased 36.2% from 4.7 ± 3.1 to 3.0 ± 1.6 (P = 0.008, interaction term P = 0.008). The decrement in information omissions was linearly associated with the number of protocol steps followed (P < 0.001). After controlling for patient stability, the intervention was still associated with reduced omissions. Handoff duration increased after standardization from 4.1 ± 3.3 to 8.0 ± 3.9 minutes (P < 0.001). ICU mortality and length of stay did not change postimplementation.
CONCLUSION:Standardizing OR to ICU handoffs significantly improved information exchange in 2 mixed surgical ICUs, with a concomitant increase in handoff duration. Additional research is needed to identify barriers to and facilitators of handoff protocol adherence.</abstract><cop>United States</cop><pub>Wolters Kluwer Health, Inc. All rights reserved</pub><pmid>30499797</pmid><doi>10.1097/SLA.0000000000003137</doi><tpages>10</tpages></addata></record> |
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| subjects | Critical Care - standards Grounded Theory Humans Intensive Care Units - standards Interdisciplinary Communication Operating Rooms - standards Patient Handoff - standards Patient Transfer - standards Pennsylvania Postoperative Period Prospective Studies Qualitative Research Surveys and Questionnaires |
| title | A Partially Structured Postoperative Handoff Protocol Improves Communication in 2 Mixed Surgical Intensive Care Units: Findings From the Handoffs and Transitions in Critical Care (HATRICC) Prospective Cohort Study |
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