title: A handoff protocol from the cardiovascular operating room to cardiac ICU is associated with improvements in care beyond the immediate postoperative period.
abstract: BACKGROUND
  Handoff protocols from the cardiovascular operating room (CVOR) to the cardiac intensive care unit (CICU) can improve patient outcomes and delivery of care beyond the immediate postoperative period. In a prospective quality improvement study, a structured CVOR-to-CICU handoff protocol was implemented at a university-affiliated children's hospital. As a parallel project, an initiative to reduce unplanned extubations in the CICU was implemented.
  
  
  METHODS
  In a 41-month period, 1,507 neonates, infants, children, and adults were admitted to the CICU from the CVOR after undergoing a surgical procedure. The study was divided into a 17-month prehandoff-protocol period (January 2009-May 2010) and a 24-month posthandoff-protocol period (June 2010-May 2012). The handoff protocol was intended to streamline the handoff process from the CVOR and throughout the transition to the CICU. The specifics of the handoff, as outlined in a bedside laminated flowchart, included patient transport from the CVOR, the cardiovascular surgeon's report, the anesthesiologist's report, and the patient status summary and care plan.
  
  
  RESULTS
  After introduction of the handoff protocol, there was a statistically significant and sustained reduction in the mean rate of unplanned extubations from 0.62 to 0.24 per 100 ventilator-days (p = .03). There was a statistically significant reduction in median ventilator time per patient--from 17 hours (interquartile range [IQR]: 5.3 to 57.7) to 12.8 hours (IQR: 4.8 to 31.8); p = .02). The mean rate of unplanned extubations was 0.26 in 2011 and 0.30 in 2012.
  
  
  CONCLUSIONS
  Implementation of a handoff protocol from the CVOR to the CICU was associated with sustained decrease in unplanned extubations and in mean ventilator times.
authors.affiliation: The Heart Institute and Department of Pediatrics, Children's Hospital Colorado, Aurora, CO, USA. Jonathan.Kaufman@childrenscolorado.org
authors.forename: Jon
authors.initials: J
authors.lastname: Kaufmnan
authors.forename: Mark
authors.initials: M
authors.lastname: Twite
authors.forename: Cindy
authors.initials: C
authors.lastname: Barrett
authors.forename: Christine
authors.initials: C
authors.lastname: Peyton
authors.forename: Julianne
authors.initials: J
authors.lastname: Koehler
authors.forename: Michael
authors.initials: M
authors.lastname: Rannie
authors.forename: Michael G
authors.initials: MG
authors.lastname: Kahn
authors.forename: Samuel
authors.initials: S
authors.lastname: Schofield
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Ing
authors.forename: James
authors.initials: J
authors.lastname: Jaggers
authors.forename: Daniel
authors.initials: D
authors.lastname: Hyman
authors.forename: Eduardo M
authors.initials: EM
authors.lastname: da Cruz
mesh_terms: D000046:Academic Medical Centers; D060666:Airway Extubation / Q000706:statistics & numerical data; D013504:Cardiovascular Surgical Procedures; D003120:Colorado; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration*; D009873:Operating Rooms / Q000458:organization & administration*; D062209:Patient Handoff / Q000458:organization & administration*; D011184:Postoperative Period; D017410:Practice Guidelines as Topic; D011787:Quality of Health Care / Q000458:organization & administration; D012121:Respiration, Artificial / Q000706:statistics & numerical data