Standardized postoperative handover process improves outcomes in the intensive care unit: a model for operational sustainability and improved team performance*.
OBJECTIVE
To determine whether structured handover tool from operating room to pediatric cardiac intensive care unit following cardiac surgery is associated with a reduction in the loss of information transfer and an improvement in the quality of communication exchange. In addition, whether this tool is associated with a decrease in postoperative complications and an improvement in patient outcomes in the first 24 hrs of pediatric cardiac intensive care unit stay.


METHODS
Prospective observational clinical study.


METHODS
Pediatric cardiac intensive care unit of an academic medical center.


METHODS
Pediatric cardiac surgery patients over a 3-yr period. Evaluation of communication and patients studied for two time periods: verbal handover (July 2007-June 2009) and structured handover (July 2009-June 2010).


METHODS
None.


RESULTS
Two anonymous surveys administered to the entire clinical team of the pediatric cardiac intensive care unit evaluated loss of information transfer for each of the two handover processes. Quality of structured handover tool was evaluated by Likert scale responses in the second survey. Patient complications including cardiopulmonary resuscitation, mediastinal reexploration, placement on extracorporeal membrane oxygenation, development of severe metabolic acidosis, and number of early extubations in the first 24-hr pediatric cardiac intensive care unit stay were compared for the two time periods. Survey results showed the general opinion that the structured handover tool was of excellent quality to enhance communication (Likert scale: 4.4 ± 0.7). In addition, the tool was associated with a significant reduction (p < .001) in loss of information for every category of patient clinical care including patient, preoperative, anesthesia, operative, and postoperative details and laboratory values. Patient data revealed significant decrease (p < .05) for three of the four major complications studied and a significant increase (p < .04) in the number of early extubations following introduction of our standardized handover tool.


CONCLUSIONS
In this setting, a standardized handover tool is associated with a decrease in the loss of patient information, an improvement in the quality of communication during postoperative transfer, a decrease in postoperative complications, and an improvement in 24-hr patient outcomes.
Department of Pediatrics, Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, TN, USA. Hemant.Agarwal@Vanderbilt.edu
Hemant S
HS
Agarwal
Benjamin R
BR
Saville
Jennifer M
JM
Slayton
Brian S
BS
Donahue
Suanne
S
Daves
Karla G
KG
Christian
David P
DP
Bichell
Zena L
ZL
Harris
D000046:Academic Medical Centers; D006348:Cardiac Surgical Procedures; D002648:Child; D002675:Child, Preschool; D003142:Communication; D003266:Continuity of Patient Care / Q000458:organization & administration*; D005260:Female; D006801:Humans; D015278:Intensive Care Units, Pediatric; D008297:Male; D017063:Outcome Assessment, Health Care; D010348:Patient Care Team; D010360:Patient Transfer / Q000458:organization & administration*; D011183:Postoperative Complications / Q000517:prevention & control*; D011446:Prospective Studies; D011785:Quality Assurance, Health Care; D058996:Quality Improvement; D011795:Surveys and Questionnaires