Coaching Operating Room to PACU Handoff with a ...
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Purpose To pilot a standardized multidisciplinary bedside handoff for any patient admitted to the post-anesthesia care unit (PACU) from the operating room. Introduction • Breakdown in communication has been attributed to 70% of sentinel adverse events. • Studies suggest education and implementation of a standardized beside handoff checklist may improve transitions of care may. • We successfully implemented a handoff process from the operating room to the surgical intensive care unit (SICU) at our institution in 2018 using the Team STEPPS I-PASS framework. • Inspired by their experience with the SICU handoff process, the PACU Nursing Council at our institution expressed interest in implementing a similar I-PASS checklist for more consistent, multidisciplinary handoffs from the operating room to PACU teams. Methods • Multidisciplinary group comprised of surgery, nursing, and anesthesia representatives developed an I-PASS handoff checklist for patients admitted from the operating room to PACU. • We performed a pre-pilot survey to characterize clinician attitudes on the current handoff process. • We provided training to surgery residents and fellows, anesthesia residents, certified registered nurse anesthetists (CRNA), and nurses at departmental meetings and piloted the process with all general surgery patients. • We performed direct observations over a two-week period to identify compliance with handoff components and make adjustments to the handoff checklist tool to meet the needs of all team members. Results • 19 direct observations over 2 weeks • 7 operative services • Average duration: 152 seconds or 2.5 minutes • All teams present: 19/19 • Nursing engagement: 18/19 • Delays/pauses: 5/19 • Redirections: 5/19 • Handoff Tool was revised based feedback from nurses and surgery residents. Next Steps • We plan to perform a post-pilot survey to obtain feedback on the new process. • We will then provide education to the other surgical departments to implement the OR to PACU handoff process with these additional teams. Conclusion • The pre-pilot survey showed a need for a standardized handoff process for patients being admitted to the PACU from the OR. • The current pilot study demonstrated the feasibility of a multidisciplinary handoff for postoperative patients admitted to the PACU. Coaching Operating Room to PACU Handoff with a Standardized, Multidisciplinary Checklist Courtney L. Devin, MD 1 ; Kathleen Grife, RN, MS 1,2 ; Marissa Weber, MD 2 ; Richard F. Schmidt, MD 3 ; Megan P. Lundgren, MD 1 ; Scott W. Cowan, MD 1 1 Department of Surgery, Thomas Jefferson University Hospital 2 Department of Anesthesiology, Thomas Jefferson University, 3 Department of Neurosurgery, Thomas Jefferson University Hospital Hospital Pre-Intervention Survey Operating Room to PACU Handoff Tool Organized Efficient Comprehensive Safe All Responses 21.98% 35.56% 15.38% 23.08% Nurses 14.29% 22.86% 11.43% 17.14% Surgery Residents 11.11% 25.71% 5.56% 13.89% Anesthesia Residents 58.33% 91.67% 25.00% 41.67% CRNAs 50.00% 50.00% 62.50% 62.50% Plans are relayed Cooperation between OR + PACU Satisfied with current status All Responses 21.74% 43.96% 19.57% Nurses 17.14% 25.71% 5.71% Surgery Residents 27.78% 50.00% 19.44% Anesthesi a residents 0.00% 50.00% 33.33% CRNAs 44.44% 87.50% 55.56%
Transcript of Coaching Operating Room to PACU Handoff with a ...
Purpose
To pilot a standardized multidisciplinary bedside handoff for any patient admitted to the post-anesthesia care unit (PACU) from the operating room.
Introduction
• Breakdown in communication has been attributed to 70% of sentinel adverse events.
• Studies suggest education and implementation of a standardized beside handoff checklist may improve transitions of care may.
• We successfully implemented a handoff process from the operating room to the surgical intensive care unit (SICU) at our institution in 2018 using the Team STEPPS I-PASS framework.
• Inspired by their experience with the SICU handoff process, the PACU Nursing Council at our institution expressed interest in implementing a similar I-PASS checklist for more consistent, multidisciplinary handoffs from the operating room to PACU teams.
Methods
• Multidisciplinary group comprised of surgery, nursing, and anesthesia representatives developed an I-PASS handoff checklist for patients admitted from the operating room to PACU.
• We performed a pre-pilot survey to characterize clinician attitudes on the current handoff process.
• We provided training to surgery residents and fellows, anesthesia residents, certified registered nurse anesthetists (CRNA), and nurses at departmental meetings and piloted the process with all general surgery patients.
• We performed direct observations over a two-week period to identify compliance with handoff components and make adjustments to the handoff checklist tool to meet the needs of all team members.
Results
• 19 direct observations over 2 weeks• 7 operative services• Average duration: 152 seconds or 2.5 minutes• All teams present: 19/19• Nursing engagement: 18/19• Delays/pauses: 5/19 • Redirections: 5/19• Handoff Tool was revised based feedback from nurses
and surgery residents.
Next Steps
• We plan to perform a post-pilot survey to obtain feedback on the new process.
• We will then provide education to the other surgical departments to implement the OR to PACU handoff process with these additional teams.
Conclusion
• The pre-pilot survey showed a need for a standardized handoff process for patients being admitted to the PACU from the OR.
• The current pilot study demonstrated the feasibility of a multidisciplinary handoff for postoperative patients admitted to the PACU.
Coaching Operating Room to PACU Handoff with a Standardized, Multidisciplinary ChecklistCourtney L. Devin, MD1; Kathleen Grife, RN, MS1,2; Marissa Weber, MD2; Richard F. Schmidt, MD3; Megan P. Lundgren, MD1; Scott W. Cowan, MD1
1Department of Surgery, Thomas Jefferson University Hospital 2Department of Anesthesiology, Thomas Jefferson University, 3Department of Neurosurgery, Thomas Jefferson University Hospital Hospital
Pre-Intervention Survey
Operating Room to PACU Handoff Tool
Organized Efficient Comprehensive SafeAll Responses 21.98% 35.56% 15.38% 23.08%Nurses 14.29% 22.86% 11.43% 17.14%Surgery Residents 11.11% 25.71% 5.56% 13.89%Anesthesia Residents 58.33% 91.67% 25.00% 41.67%CRNAs 50.00% 50.00% 62.50% 62.50%
Plans are relayed
Cooperation between OR + PACU
Satisfied with current status
All Responses 21.74% 43.96% 19.57%Nurses 17.14% 25.71% 5.71%Surgery Residents 27.78% 50.00% 19.44%Anesthesia residents 0.00% 50.00% 33.33%CRNAs 44.44% 87.50% 55.56%
