Intraoperative Handover Checklist of Anesthesia Care Improves Outcomes Among Patients Undergoing Major Surgery

Study Overview
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Brief Summary
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Implementation of a standardized handover checklist for intraoperative anesthesia care transition attenuates burnout among anesthesiologists and improves postoperative outcomes of patients undergoing major surgery , both of which benefit the quality of patient care and the development of anesthesiology.

Detailed Description
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Many retrospective studies have demonstrated that among adults undergoing major surgery, complete handover of intraoperative anesthesia care compared with no handover was associated with a higher risk of adverse postoperative outcomes. Anesthesiologists keeping on working without handovers may experience symptoms of burnout which do not only pose a threat to the mental and physical health of the anesthesiologist, but also result in sub-optimal safety care of patients. Poor-quality handover without standardized processes can lead to diagnostic and therapeutic delays and precipitate adverse events. An improved system of anesthesia standardized handovers using a checklist would improve transfer of information and professional responsibility and therefore lead to the improvement of patient safety as well as burnout among anesthesiologists. Thus it is urgent to develop a standardized handover checklist for intraoperative anesthesia care to improve postoperative outcome of patients.

Official Title
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Intraoperative Handover Checklist of Anesthesia Care Improves Postoperative Outcomes Among Patients Undergoing Major Surgery: a Multicenter, Before-after Cohort Study

Conditions
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Anesthesia, Surgery--Complications, Burnout, Professional

Intervention / Treatment
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* Device: standardized handover checklist


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Adult patients aged 18 years and older undergoing major surgeries requiring a hospital stay of at least 1 night are enrolled in this study. Exclusion Criteria: Adult patients aged less than 18 years undergoing major surgeries and were not requiring a hospital stay of at least 1 night are excluded.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| baseline or control group<br>All participant anesthesiologists do intraoperative handover of anesthesia care according to a usual process or without checklist for 2-week to 1-month baseline data collection. | |
| Checklist group<br>All participant anesthesiologists do intraoperative handover of anesthesia care by using a standardized handover checklist for another 2-week to 1-month data collection. | Device: standardized handover checklist<br>* Following a review of relevant literatures and guidelines, a checklist consisting of the various key items necessary for giving continuing and safe intraoperative patient care was designed and validated by anesthesia residents and staff. Following 2-week to 1-month baseline data collection, each anesthesiologists and anesthesia residents in participating hospitals were asked to implement the safe-anesthesia checklist to improve practice over another 2-week to 1-month period. The checklist consists of an oral confirmation and closed-loop communication between the primary anesthesiologist and the replacement anesthesiologist. Evaluation of the effect of implementation of a standardized checklist during anesthesia care handover on patient safety during follow-up.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Incidence of a composite of all-cause death, hospital readmission, or major postoperative complications | The primary outcome that will be measured is a composite of all-cause death, hospital readmission, or major postoperative complications, all within 30 days post surgery | 30 days | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Incidence of 7 day-, 30 day-, 90 day- and inhospital mortality | 7/30/90-day mortality, inhospital mortality | 7/30/90 day | 
| Incidence of major complications | Postoperative major complications, defined by International Classification of Diseases, Tenth Revision (ICD-10) diagnostic codes | 30 days | 
| Incidence of ICU admission post surgery | Incidence of postoperative intensive care unit (ICU) admission, ,within 30 days post surgery | 30 days | 
| The time of hospital length of stay (LOS) | Hospital length of stay (LOS) | up to 30 days | 
| Incidence of emergency department (ED) visits | Emergency department (ED) visits within 90 days of the index surgery | 90 days | 
| Any medical cost during hospital stay | Any medical cost during hospital stay | up to 90 days | 
| Ventilation time within postoperative 30 days | Ventilation time within postoperative 30 days | Up to 30 days | 
| Anaesthetic resuscitation time | Anaesthetic resuscitation time after the surgery is completed | Up to 24 hours | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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major surgery, ansethesia care, postoperative complication, handover checklist, anesthesiologist burnout