title: Sustainability of protocolized handover of pediatric cardiac surgery patients to the intensive care unit.
abstract: BACKGROUND
  Transfer of patient care among clinicians (handovers) is a common source of medical errors. While the immediate efficacy of these initiatives is well documented, sustainability of practice changes that results in better processes of care is largely understudied.
  
  
  OBJECTIVE
  The objective of the current investigation was to evaluate the sustainability of a protocolized handover process in pediatric patients from the operating room after cardiac surgery to the intensive care unit.
  
  
  METHODS
  This was a prospective study with direct observation assessment of handover performance conducted in the cardiac ICU (CICU) of a free-standing, tertiary care children's hospital in the United States. Patient transitions from the operating room to the CICU, including the verbal handoff, were directly observed by a single independent observer in all phases of the study. A checklist of key elements identified errors classified as: (1) technical, (2) information omissions, and (3) realized errors. Total number of errors was compared across the different times of the study (preintervention, postintervention, and the current sustainability phase).
  
  
  RESULTS
  A total of 119 handovers were studied: 41 preintervention, 38 postintervention, and 40 in the current sustainability phase. The median [Interquartile range (IQR)] number of technical errors was significantly reduced in the sustainability phase compared to the preintervention and postintervention phase, 2 (1-3), 6 (5-7), and 2.5 (2-4), respectively P = 0.0001. Similarly, the median (IQR) number of verbal information omissions was also significantly reduced in the sustainability phase compared to the preintervention and postintervention phases, 1 (1-1), 4 (3-5) and 2 (1-3), respectively.
  
  
  CONCLUSIONS
  We demonstrate sustainability of an improved handover process using a checklist in children being transferred to the intensive care unit after cardiac surgery. Standardized handover processes can be a sustainable strategy to improve patient safety after pediatric cardiac surgery.
authors.affiliation: Department of Pediatric Anesthesiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Chicago, IL, USA.
authors.forename: Kristin
authors.initials: K
authors.lastname: Chenault
authors.affiliation: Department of Paediatrics, University of Toronto, Toronto, ON, Canada.|Department of Critical Care Medicine, The Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, ON, Canada.
authors.forename: Michael-Alice
authors.initials: MA
authors.lastname: Moga
authors.affiliation: Department of Pediatric Anesthesiology, Phoenix Children's Hospital, Phoenix, AR, USA.
authors.forename: Minah
authors.initials: M
authors.lastname: Shin
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Chicago, IL, USA.
authors.forename: Emily
authors.initials: E
authors.lastname: Petersen
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Chicago, IL, USA.
authors.forename: Carl
authors.initials: C
authors.lastname: Backer
authors.affiliation: Department of Anesthesiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
authors.forename: Gildasio S
authors.initials: GS
authors.lastname: De Oliveira
authors.affiliation: Department of Pediatric Anesthesiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Chicago, IL, USA.
authors.forename: Santhanam
authors.initials: S
authors.lastname: Suresh
mesh_terms: D006348:Cardiac Surgical Procedures / Q000379:methods*; D057189:Checklist; D002648:Child; D002985:Clinical Protocols; D003266:Continuity of Patient Care; D003422:Critical Care / Q000458:organization & administration*; D005568:Forms and Records Control; D006801:Humans; D015278:Intensive Care Units, Pediatric / Q000458:organization & administration*; D019300:Medical Errors; D009873:Operating Rooms / Q000458:organization & administration; D062209:Patient Handoff / Q000592:standards*; D019990:Perioperative Care / Q000592:standards; D011446:Prospective Studies; D062606:Tertiary Care Centers
keywords: cardiac; handover; pediatric; surgery; sustainability