title: A Multimodal Intervention Improves Postanesthesia Care Unit Handovers.
abstract: BACKGROUND
  Failures of communication are a major contributor to perioperative adverse events. Transitions of care may be particularly vulnerable. We sought to improve postoperative handovers.
  
  
  METHODS
  We introduced a multimodal intervention in an adult and a pediatric postanesthesia care unit (PACU) to improve postoperative handovers between anesthesia providers (APs) and PACU registered nurses (RNs). The intervention included a standardized electronic handover report form, a didactic webinar, mandatory simulation training focused on improving interprofessional communication, and post-training performance feedback. Trained, blinded nurse observers scored PACU handovers during 17 months using a structured tool consisting of 8 subscales and a global score (1-5 scale). Multivariate logistic regression assessed the effect of the intervention on the proportion of observed handovers receiving a global effectiveness rating of ≥3.
  
  
  RESULTS
  Four hundred fifty-two clinicians received the simulation-based training, and 981 handovers were observed and rated. In the adult PACU, the estimated percentages of acceptable handovers (global ratings ≥3) among AP-RN pairs, where neither received simulation-based training (untrained dyads), was 3% (95% confidence interval, 1%-11%) at day 0, 10% (5%-19%) at training initiation (day 40), and 57% (33%-78%) at 1-year post-training initiation (day 405). For AP-RN pairs where at least one received the simulation-based training (trained dyads), these percentages were estimated to be 18% (11%-28%) and 68% (57%-76%) on days 40 and 405, respectively. The percentage of acceptable handovers was significantly greater on day 405 than it was on day 40 for both untrained (P < 0.001) and trained dyads (P < 0.001). Similar patterns were observed in the pediatric PACU. Three years later, the unadjusted estimate of the probability of an acceptable handover was 87% (72%-95%) in the adult PACU and 56% (40%-72%) in the pediatric PACU.
  
  
  CONCLUSIONS
  A multimodal intervention substantially improved interprofessional PACU handovers, including those by clinicians who had not undergone formal simulation training. An effect appeared to be present >3 years later.
authors: From the Center for Research and Innovation in Systems Safety (CRISS), Institute for Medicine and Public Health, Vanderbilt University, Nashville, Tennessee; Health Services Research Division and the Geriatrics Research Education and Clinical Center, Veterans Affairs (VA) Tennessee Valley Healthcare System, Nashville Campus, Nashville, Tennessee; Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, Tennessee; Center for Experiential Learning and Assessment, Department of Medical Education, Vanderbilt University School of Medicine, Nashville, Tennessee; Perioperative Nursing and Nurse Education, Vanderbilt University Medical Center, Nashville, Tennessee; Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee; Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, Tennessee; School of Nursing, Vanderbilt University, Nashville, Tennessee; Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee; and Health Information Management and Systems Division, School of Health and Rehabilitation Sciences, Ohio State University College of Medicine, Columbus, Ohio.
authors: Matthew B
authors: MB
authors: Weinger
authors: Jason M
authors: JM
authors: Slagle
authors: Audrey H
authors: AH
authors: Kuntz
authors: Jonathan S
authors: JS
authors: Schildcrout
authors: Arna
authors: A
authors: Banerjee
authors: Nathaniel D
authors: ND
authors: Mercaldo
authors: James L
authors: JL
authors: Bills
authors: Kenneth A
authors: KA
authors: Wallston
authors: Theodore
authors: T
authors: Speroff
authors: Emily S
authors: ES
authors: Patterson
authors: Daniel J
authors: DJ
authors: France
mesh_terms: D000328:Adult; D000368:Aged; D000758:Anesthesia / Q000592:standards* / Q000639:trends; D015331:Cohort Studies; D003131:Combined Modality Therapy / Q000592:standards / Q000639:trends; D003266:Continuity of Patient Care / Q000592:standards / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D062209:Patient Handoff / Q000592:standards* / Q000639:trends; D011182:Postoperative Care / Q000592:standards* / Q000639:trends