POSTANESTHESIA HANDOFF: AN EVIDENCE-BASED QUALITY IMPROVEMENT PROJECT
Creators: name: Shenkosky, Susan
Publisher: name: Zenodo
Year: 2018

description: Patient handoffs between healthcare providers occur multiple times a day. Poor communication during these transitions of care may jeopardize patient safety. Standardization of handoffs and the use of cognitive aids, such as checklists, can improve communication and prevent errors. Studies show that incorporating the use of checklists in preoperative and intraoperative care reduces morbidity and mortality. The purpose of this project was to improve patient handoff communication between anesthesia providers and post-anesthesia care unit (PACU) staff through the implementation of a standardized handoff checklist. This quality improvement (QI) project occurred at a large urban academic medical center in the perioperative department. A committee comprised of anesthesiologists and certified registered nurse anesthetists (CRNAs) with consultant registered nurses (RNs) from the post-anesthesia care unit developed a cognitive aid checklist using available literature and considering the practice setting, patient population, and department culture. To assess baseline information on handoff processes, the author conducted patient handoff observations using the checklist tool. The committee offered all anesthesia staff training on a safe patient handoff and the new checklist procedure. The author conducted a post-training assessment of knowledge acquisition and observations of the application of patient handoffs. The sample consisted of 195 anesthesia providers (36 SRNAs, 28 CRNAs, 55 residents and 76 anesthesiologists) received education related to the checklist via email; approximately 76 also participated in face-to-face training (36 SRNAs, 20 CRNAs, and 20 residents). Prior to the training, the author conducted 68 handoff observations; none iv included all required checklist elements. Only 65 providers completed the pre- or posttraining knowledge and attitude survey (response rates, 27.2%, 6.2% respectively). In post-training handoff observations assessments of information transfer and checklist use, only 10.9% of the providers used the checklist during their handoff report. A comparison of the pre- and post-knowledge and attitude surveys did not support the educational training influencing the knowledge and skills of the providers regarding safe handoff practices. Responses to these two surveys were poor and, in fact, may reflect a lack of buy-in of the project by the stakeholders. From pre- to post-training only a 4% increase in information transferred during handoffs occurred. However, a post-training comparison of handoffs with and without checklist use revealed a 21.6% increase in information transfer when staff used the checklist. The project revealed that further examination of the barriers to quality improvement implementation and strategies for staff participation in practice change is necessary. Lessons learned during the process include the need for increased time and resources in the planning phase to aid in the implementation of a QI project in large public, academic medical centers. In future QI projects, the author recommends researching strategies to improve staff input and senior staff buy-in and support. Considering incentives for phases throughout implementation is suggested.