title: Improvement in Patient Transfer Process From the Operating Room to the PICU Using a Lean and Six Sigma-Based Quality Improvement Project.
abstract: OBJECTIVE
  Ineffective and inefficient patient transfer processes can increase the chance of medical errors. Improvements in such processes are high-priority local institutional and national patient safety goals. At our institution, nonintubated postoperative pediatric patients are first admitted to the postanesthesia care unit before transfer to the PICU. This quality improvement project was designed to improve the patient transfer process from the operating room (OR) to the PICU.
  
  
  METHODS
  After direct observation of the baseline process, we introduced a structured, direct OR-PICU transfer process for orthopedic spinal fusion patients. We performed value stream mapping of the process to determine error-prone and inefficient areas. We evaluated primary outcome measures of handoff error reduction and the overall efficiency of patient transfer process time. Staff satisfaction was evaluated as a counterbalance measure.
  
  
  RESULTS
  With the introduction of the new direct OR-PICU patient transfer process, the handoff communication error rate improved from 1.9 to 0.3 errors per patient handoff (P = .002). Inefficiency (patient wait time and non-value-creating activity) was reduced from 90 to 32 minutes. Handoff content was improved with fewer information omissions (P < .001). Staff satisfaction significantly improved among nearly all PICU providers.
  
  
  CONCLUSIONS
  By using quality improvement methodology to design and implement a new direct OR-PICU transfer process with a structured multidisciplinary verbal handoff, we achieved sustained improvements in patient safety and efficiency. Handoff communication was enhanced, with fewer errors and content omissions. The new process improved efficiency, with high staff satisfaction.
authors.affiliation: Departments of Pediatrics, Anesthesiology, gleich.stephen@mayo.edu.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Gleich
authors.affiliation: Departments of Pediatrics, Anesthesiology.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Nemergut
authors.affiliation: Orthopedics, and.
authors.forename: Anthony A
authors.initials: AA
authors.lastname: Stans
authors.affiliation: Anesthesiology.
authors.forename: Dawit T
authors.initials: DT
authors.lastname: Haile
authors.affiliation: Nursing, Mayo Clinic, Rochester, Minnesota; and.
authors.forename: Scott A
authors.initials: SA
authors.lastname: Feigal
authors.affiliation: Nursing, Mayo Clinic, Rochester, Minnesota; and.
authors.forename: Angela L
authors.initials: AL
authors.lastname: Heinrich
authors.affiliation: Anesthesiology.
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Bosley
authors.affiliation: Department of Clinical Pediatrics, University of Illinois College of Medicine, Peoria, Illinois.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Tripathi
mesh_terms: D002648:Child; D003266:Continuity of Patient Care / Q000458:organization & administration / Q000592:standards; D005260:Female; D006801:Humans; D015278:Intensive Care Units, Pediatric / Q000592:standards; D008297:Male; D019300:Medical Errors / Q000517:prevention & control*; D017146:Models, Organizational; D009873:Operating Rooms / Q000592:standards; D062209:Patient Handoff / Q000592:standards*; D010360:Patient Transfer / Q000379:methods / Q000458:organization & administration; D058996:Quality Improvement; D013123:Spinal Fusion / Q000379:methods; D017749:Total Quality Management / Q000379:methods