Training in intraoperative handover and display of a checklist improve communication during transfer of care: An interventional cohort study of anaesthesia residents and nurse anaesthetists

Marion Jullia, Anaïs Tronet, Fabiola Fraumar, Vincent Minville, Olivier Fourcade, Xavier Alacoque, Yannick LeManach, Matt M Kurrek, Marion Jullia, Anaïs Tronet, Fabiola Fraumar, Vincent Minville, Olivier Fourcade, Xavier Alacoque, Yannick LeManach, Matt M Kurrek

Abstract

Background: Handovers during anaesthesia are common, and failures in communication may lead to morbidity and mortality.

Objectives: We hypothesised that intraoperative handover training and display of a checklist would improve communication during anaesthesia care transition in the operating room.

Design: Interventional cohort study.

Setting: Single-centre tertiary care university hospital.

Participants: A total of 204 random observations of handovers between anaesthesia providers (residents and nurse anaesthetists) over a 6-month period in 2016.

Intervention: Two geographically different hospital sites were studied simultaneously (same observations, but no training/checklist at the control site): first a 2-week 'baseline' observation period; then handover training and display of checklists in each operating room (at the intervention site only) followed by an 'immediate' second and finally a third (3 months later) observation period.

Main outcome measures: A 22-item checklist was created by a modified DELPHI method and a checklist score calculated for each handover by adding the individual scores for each item as follows: -1, if error in communicating item; 0, unreported item; 0.5, if partly communicated item; 1, if correctly communicated item.

Results: Before training and display of the checklist, the scores in the interventional and the control groups were similar. There was no improvement in the control group's scores over the three observation periods. In the interventional group, the mean (95% confidence interval) score increased by 43% [baseline 7.6 (6.7 to 8.4) n = 42; 'immediate' 10.9 (9.4 to 12.4) n = 27, P < 0.001]. This improvement persisted at 3 months without an increase in the mean duration of handovers.

Conclusion: Intraoperative handover training and display of a checklist in the operating room improved the checklist score for intraoperative transfer of care in anaesthesia.

Figures

Fig. 1
Fig. 1
Intraoperative handover quality score. See text for details. Mean values. Bars represent SD. ∗P < 0.001 compared with baseline, and between sites.

References

    1. Hudson CCC, McDonald B, Hudson JKC, et al. Impact of anesthetic handover on mortality and morbidity in cardiac surgery: a cohort study. J Cardiothorac Vasc Anesth 2015; 29:11–16.
    1. Saager L, Hesler BD, You J, et al. Intraoperative transitions of anesthesia care and postoperative adverse outcomes. Anesthesiology 2014; 121:695–706.
    1. Hyder JA, Bohman JK, Kor DJ, et al. Anesthesia care transitions and risk of postoperative complications. Anesth Analg 2016; 122:134–144.
    1. Nasca TJ, Day SH, Amis ES., Jr The new recommendations on duty hours from the ACGME Task Force. N Engl J Med 2010; 363:e3.
    1. Weinger MB, Slagle JM, Kuntz AH, et al. A multimodal intervention improves postanesthesia care unit handovers. Anesth Analg 2015; 121:957–971.
    1. Segall N, Bonifacio AS, Schroeder RA, et al. Can we make postoperative patient handovers safer? A systematic review of the literature. Anesth Analg 2012; 115:102–115.
    1. Salzwedel C, Bartz H-J, Kühnelt I, et al. The effect of a checklist on the quality of postanaesthesia patient handover: a randomized controlled trial. Int J Qual Healthcare 2013; 25:176–181.
    1. Lane-Fall MB, Brooks AK, Wilkins SA, et al. Addressing the mandate for hand-off education: a focused review and recommendations for anesthesia resident curriculum development and evaluation. Anesthesiology 2014; 120:218–229.
    1. Harris PA, Taylor R, Thielke R, et al. Research electronic data capture (REDCap) – a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009; 42:377–381.
    1. Choromanski D, Frederick J, McKelvey GM, et al. Intraoperative patient information handover between anesthesia providers. J Biomed Res 2014; 28:383–387.
    1. Agarwala AV, Firth PG, Albrecht MA, et al. An electronic checklist improves transfer and retention of critical information at intraoperative handoff of care. Anesth Analg 2015; 120:96–104.
    1. Boat AC, Spaeth JP. Handoff checklists improve the reliability of patient handoffs in the operating room and postanesthesia care unit. Paediatr Anaesth 2013; 23:647–654.
    1. Starmer AJ, Spector ND, Srivastava R, et al. Changes in medical errors after implementation of a handoff program. N Engl J Med 2014; 371:1803–1812.
    1. Starmer AJ, Sectish TC, Simon DW, et al. Rates of medical errors and preventable adverse events among hospitalized children following implementation of a resident handoff bundle. JAMA 2013; 310:2262–2270.
    1. Petrovic MA, Aboumatar H, Scholl AT, et al. The perioperative handoff protocol: evaluating impacts on handoff defects and provider satisfaction in adult perianesthesia care units. J Clin Anesth 2015; 27:111–119.
    1. Jayaswal S, Berry L, Leopold R, et al. Evaluating safety of handoffs between anesthesia care providers. Ochsner J 2011; 11:99–101.
    1. Robertson ER, Morgan L, Bird S, et al. Interventions employed to improve intrahospital handover: a systematic review. BMJ Qual Saf 2014; 23:600–607.
    1. Terekhov MA, Ehrenfeld JM, Dutton RP, et al. Intraoperative care transitions are not associated with postoperative adverse outcomes. Anesthesiology 2016; 125:690–699.

Source: PubMed

Спонсоры и соавторы

Заболевания

Медикаментозные вмешательства

Подписаться