title: The perioperative handoff protocol: evaluating impacts on handoff defects and provider satisfaction in adult perianesthesia care units.
abstract: OBJECTIVE
  To evaluate a new perioperative handoff protocol in the adult perianesthesia care units (PACUs).
  
  
  METHODS
  Prospective, unblinded cross-sectional study.
  
  
  METHODS
  Perianesthesia care unit in a tertiary care facility serving 55,000 patients annually.
  
  
  METHODS
  One hundred three surgery patients.
  
  
  METHODS
  During a 4-week preintervention phase, 53 perioperative handoffs were observed, and data were collected daily by a trained observer. Educational sessions were conducted to train perioperative practitioners on the new protocol. Two weeks after implementation, 50 consecutive handoffs were observed, and practitioners were surveyed with the same methodology as in the preintervention phase.
  
  
  METHODS
  Type of information shared, type and duration of procedure, total duration of handoff, number and type of providers at the bedside, number of report interruptions, environmental distractions, and any other disruptive events. Observers also tracked technical/equipment problems to include malfunctioning or compromised operation of medical equipment, such as the cardiac monitor, transducer, oxygen tank, and pulse oximeter.
  
  
  RESULTS
  A total of 103 handoffs were observed (53 preintervention and 50 postintervention). The mean number of defects per handoff decreased from 9.92 to 3.68 (P < .01). The mean number of missed information items from the surgery report decreased from 7.57 to 1.2 items per handoff and from 2.02 to 0.94 (P < .01) for the anesthesia report. Technical defects reported by unit nurses decreased from 0.34 to 0.10 (P = .04). Verbal reports delivered by surgeons increased from 21.2% to 83.3%. Although the mean duration of handoffs increased by 2 minutes (P = .01), the average time from patient arrival at PACU to handoff start was reduced by 1.5 minutes (P = .01). Satisfaction with the handoff improved significantly among PACU nurses.
  
  
  CONCLUSIONS
  The perioperative handoff protocol implementation was associated with improved information sharing and reduced handoff defects.
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: rpetrov@jhmi.edu.
authors.forename: Michelle A
authors.initials: MA
authors.lastname: Petrovic
authors.affiliation: Department of Medicine, Education and Research Associate, Armstrong Institute for Safety and Quality, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Hanan
authors.initials: H
authors.lastname: Aboumatar
authors.affiliation: Orlando, FL, USA.
authors.forename: Adam T
authors.initials: AT
authors.lastname: Scholl
authors.affiliation: The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Randeep S
authors.initials: RS
authors.lastname: Gill
authors.affiliation: The Johns Hopkins Hospital, Baltimore, MD, USA.
authors.forename: Dina A
authors.initials: DA
authors.lastname: Krenzischek
authors.affiliation: Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Melissa S
authors.initials: MS
authors.lastname: Camp
authors.affiliation: The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Carolyn M
authors.initials: CM
authors.lastname: Senger
authors.affiliation: The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Yi
authors.initials: Y
authors.lastname: Deng
authors.affiliation: The Johns Hopkins Hospital, Baltimore, MD, USA.
authors.forename: Tracy Y
authors.initials: TY
authors.lastname: Chang
authors.affiliation: The Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Yanjun
authors.initials: Y
authors.lastname: Xie
authors.affiliation: The Johns Hopkins Hospital, Baltimore, MD, USA.
authors.forename: Zahi R
authors.initials: ZR
authors.lastname: Jurdi
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Martinez
mesh_terms: D002985:Clinical Protocols; D003142:Communication; D003430:Cross-Sectional Studies; D006801:Humans; D007400:Interprofessional Relations; D008396:Maryland; D019300:Medical Errors / Q000517:prevention & control*; D009873:Operating Rooms / Q000458:organization & administration / Q000592:standards*; D010348:Patient Care Team / Q000458:organization & administration / Q000592:standards; D062209:Patient Handoff / Q000458:organization & administration / Q000592:standards*; D010360:Patient Transfer / Q000458:organization & administration / Q000592:standards; D019990:Perioperative Care / Q000592:standards*; D010549:Personal Satisfaction; D058996:Quality Improvement; D062606:Tertiary Care Centers / Q000592:standards
keywords: Handoffs; Handovers; PACU; Perioperative; Transfers; Transitions