Patient handover from surgery to intensive care: using Formula 1 pit-stop and aviation models to improve safety and quality.
BACKGROUND
We aimed to improve the quality and safety of handover of patients from surgery to intensive care using the analogy of a Formula 1 pit stop and expertise from aviation.


METHODS
A prospective intervention study measured the change in performance before and after the implementation of a new handover protocol that was developed through detailed discussions with a Formula 1 racing team and aviation training captains. Fifty (23 before and 27 after) postsurgery patient handovers were observed. Technical errors and information omissions were measured using checklists, and teamwork was scored using a Likert scale. Duration of the handover was also measured.


RESULTS
The mean number of technical errors was reduced from 5.42 (95% CI +/-1.24) to 3.15 (95% CI +/-0.71), the mean number of information handover omissions was reduced from 2.09 (95% CI +/-1.14) to 1.07 (95% CI +/-0.55), and duration of handover was reduced from 10.8 min (95% CI +/-1.6) to 9.4 min (95% CI +/-1.29). Nine out of twenty-three (39%) precondition patients had more than one error in both technical and information handover prior to the new protocol, compared with three out of twnety-seven (11.5%) with the new handover. Regression analysis showed that the number of technical errors were significantly reduced with the new handover (t = -3.63, P < 0.001), and an interaction suggested that teamwork (t = 3.04, P = 0.004) had a different effect with the new handover protocol.


CONCLUSIONS
The introduction of the new handover protocol lead to improvements in all aspects of the handover. Expertise from other industries can be extrapolated to improve patient safety, and in particular, areas of medicine involving the handover of patients or information.
Catchpole
Ken R
KR
Nuffield Department of Surgery, University of Oxford, Oxford, UK. ken.catchpole@nds.ox.ac.uk
de Leval
Marc R
MR
McEwan
Angus
A
Pigott
Nick
N
Elliott
Martin J
MJ
McQuillan
Annette
A
MacDonald
Carol
C
Goldman
Allan J
AJ
D000293:Adolescent; D001359:Aviation; D006348:Cardiac Surgical Procedures; D002648:Child; D002675:Child, Preschool; D003266:Continuity of Patient Care / Q000592:standards*; D006330:Heart Defects, Congenital / Q000601:surgery; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric / Q000458:organization & administration*; D033183:Interdisciplinary Communication; D019300:Medical Errors / Q000517:prevention & control / Q000706:statistics & numerical data; D017146:Models, Organizational; D010346:Patient Care Management / Q000592:standards*; D010348:Patient Care Team / Q000458:organization & administration; D010360:Patient Transfer / Q000592:standards*; D010865:Pilot Projects; D011446:Prospective Studies; D013997:Time Factors; D017749:Total Quality Management / Q000458:organization & administration*