Improving Handoffs Between Operating Room and Pediatric Intensive Care Teams: Before and After Study

Abstract

Introduction: Patient transfer between teams and units is known to be a high-risk event for miscommunication and therefore error. We instituted a quality improvement initiative to formalize patient handoffs from the operating room (OR) to the Pediatric Intensive Care Unit (PICU). We hypothesized that measures of information transfer would improve.

Methods: In this before and after study, a multidisciplinary team developed a standardized handoff protocol (including a checklist) instituted in the Dartmouth PICU over the summer of 2016. We directly observed pediatric admissions from OR to PICU and collected data on information transfer and patient outcome metrics both before and after the institution of the handoff protocol at the time of transfer (intervention).

Results: We directly observed 52 handoffs (29 preintervention, 23 postintervention). The mean patient age was 9.3 years (SD, 6.5), with 55% male. Preintervention the average information transfer was 56% (upper control limit, 76%; lower control limit, 36%), whereas postintervention it was 81% (upper control limit, 97%, lower control limit, 65%). The improvement in information transfer postintervention was statistically significant (P < 0.001). There was no statistically significant change in maximum pain score in the first 6 hours after admission (preintervention, 4.5, SD 3.9; postintervention, 2.9, SD 1.3, P = 0.15). There was no difference in the time required for handoff pre- versus postintervention (8.7 minutes, SD 5.5 versus 10.1 minutes, SD 4.6, P = 0.34).

Conclusion: Standardization of OR to PICU patient transfers using a predetermined checklist at the time of handoff can improve the completeness of information transfer without increasing the length of the handoff.

Fig. 1.

p-Chart of percent completeness of handoffs during study period (with process change).