title: Standardizing postoperative PICU handovers improves handover metrics and patient outcomes.
abstract: OBJECTIVE
  To improve handover communication and patient outcomes for postoperative admissions to a multidisciplinary PICU.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Multidisciplinary PICU in a university hospital.
  
  
  METHODS
  The multidisciplinary team responsible for postoperative PICU admissions and patient care, including attending, fellow, house staff physicians, and nurses from pediatric critical care medicine, surgery, and anesthesia.
  
  
  METHODS
  An online survey distributed to PICU, surgery, and anesthesia providers identified existing barriers and challenges to effective postoperative PICU handovers and guided the formation of a standard protocol. Handovers for postoperative PICU admissions were then directly observed for 3 months pre- and postimplementation of the protocol, with data collected on communication, metrics, and patient outcomes. Observations and data collection, as well as the online provider survey, were repeated approximately 1 year after handover protocol implementation.
  
  
  RESULTS
  Survey data demonstrated increases in provider ratings of handover attendance, communication, and quality after implementation of the handover protocol (p < 0.001). Surgical report errors were eliminated (p = 0.03), and the prevalence of provider attendance for the handover duration increased from 39.3% to 68.2% (p = 0.01). Following protocol implementation, fewer patients experienced antibiotic delays (34.5% to 13.9%; p = 0.03) or required hemodynamic or respiratory interventions within the first 6 hours of PICU admission (24.6% to 9.1%; p = 0.04). Patients received their first dose of analgesia (62.3 to 17.4 min; p = 0.01) and had their admission laboratory studies sent (42.3 to 32.9 min; p = 0.04) more quickly. Data collected at 12 months postimplementation demonstrated sustained reductions in analgesia timing, antibiotic delays, and handover barriers.
  
  
  CONCLUSIONS
  Postoperative communication and patient outcomes can be improved and sustained over time with implementation of a standardized handover protocol.
authors.affiliation: 1Division of Pediatric Critical Care Medicine, Department of Pediatrics, Duke Children's Hospital, Duke University Medical Center, Durham, NC. 2Division of Pediatric Anesthesia, Department of Anesthesia, Duke Children's Hospital, Duke University Medical Center, Durham, NC.
authors.forename: Ryan K
authors.initials: RK
authors.lastname: Breuer
authors.forename: Brad
authors.initials: B
authors.lastname: Taicher
authors.forename: David A
authors.initials: DA
authors.lastname: Turner
authors.forename: Ira M
authors.initials: IM
authors.lastname: Cheifetz
authors.forename: Kyle J
authors.initials: KJ
authors.lastname: Rehder
mesh_terms: D000293:Adolescent; D000698:Analgesia / Q000379:methods / Q000706:statistics & numerical data; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003625:Data Collection / Q000379:methods; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric / Q000592:standards*; D008297:Male; D010343:Patient Admission / Q000706:statistics & numerical data; D010348:Patient Care Team / Q000592:standards* / Q000706:statistics & numerical data; D062209:Patient Handoff / Q000592:standards* / Q000706:statistics & numerical data*; D010360:Patient Transfer / Q000592:standards* / Q000706:statistics & numerical data; D011184:Postoperative Period; D017410:Practice Guidelines as Topic; D011446:Prospective Studies
chemical_list: D000900:Anti-Bacterial Agents