title: Leveraging Telemedicine Infrastructure to Monitor Quality of Operating Room to Intensive Care Unit Handoffs.
abstract: To analyze in-room video recordings of operating room (OR) to intensive care unit (ICU) handoffs to determine tempo and quality of team interactions on nights and weekends compared with weekdays, and to demonstrate how existing telemedicine technology can be used to evaluate handoffs.
  
  
  
  This prospective observational study of OR-to-ICU bedside handoffs was conducted in the surgical ICU of the Hospital of the University of Pennsylvania in July 2014-January 2015. Handoff video recordings were obtained for quality improvement purposes using existing telemedicine cameras. Evaluators used adapted validated in-person assessment measures to analyze basic characteristics and quality measures (timing, report types, report duration, presence of physical exam, teamwork skills, engagement, report delivery skills, listening skills, interruptions, unprofessional comments or actions).
  
  
  
  Sixteen weekday and 16 night and weekend handoffs were compared. There were no significant differences in basic characteristics. Most quality measures were similar on weekdays compared with nights and weekends. Surgeons demonstrated better report delivery skills and engagement on nights and weekends (P = .002 and P = .04, respectively), whereas OR anesthesiologists' scores were similar during both time frames.
  
  
  
  This study presents a novel approach of assessing handoff quality in OR-to-ICU handoffs using an existing telemedicine infrastructure. Using this approach, quality measures of night and weekend handoffs were found to be no worse-and sometimes better-than those during weekdays. Video analysis may emerge as an ideal unobtrusive quality improvement methodology to monitor handoffs and improve education and compliance with institutional handoff policies.
authors.affiliation: M.E. Barry is a medical student, Division of Traumatology, Surgical Critical Care, and Emergency Surgery, Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania. B.R. Hochman is assistant professor, Division of Acute Care Surgery, Department of Surgery, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, New York. M.B. Lane-Fall is assistant professor, Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, and senior fellow, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania. D. Zappile is acute care nurse practitioner, Division of Traumatology, Surgical Critical Care, and Emergency Surgery, Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania. D.N. Holena is assistant professor, Division of Traumatology, Surgical Critical Care, and Emergency Surgery, Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, and senior fellow, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania. B.P. Smith is assistant professor, Division of Traumatology, Surgical Critical Care, and Emergency Surgery, Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania. L.J. Kaplan is associate professor, Division of Traumatology, Surgical Critical Care, and Emergency Surgery, Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania. A. Huffenberger is director of operations, Penn E-lert Telemedicine Program, University of Pennsylvania Health System, Philadelphia, Pennsylvania. P.M. Reilly is chief and professor, Division of Traumatology, Surgical Critical Care, and Emergency Surgery, Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania. J.L. Pascual is associate professor, Division of Traumatology, Surgical Critical Care, and Emergency Surgery, Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Mark E
authors.initials: ME
authors.lastname: Barry
authors.forename: Beth R
authors.initials: BR
authors.lastname: Hochman
authors.forename: Meghan B
authors.initials: MB
authors.lastname: Lane-Fall
authors.forename: Denise
authors.initials: D
authors.lastname: Zappile
authors.forename: Daniel N
authors.initials: DN
authors.lastname: Holena
authors.forename: Brian P
authors.initials: BP
authors.lastname: Smith
authors.forename: Lewis J
authors.initials: LJ
authors.lastname: Kaplan
authors.forename: Ann
authors.initials: A
authors.lastname: Huffenberger
authors.forename: Patrick M
authors.initials: PM
authors.lastname: Reilly
authors.forename: Jose L
authors.initials: JL
authors.lastname: Pascual
mesh_terms: D006801:Humans; D007362:Intensive Care Units / Q000592:standards*; D009873:Operating Rooms / Q000592:standards*; D062209:Patient Handoff / Q000592:standards*; D010360:Patient Transfer / Q000592:standards*; D010414:Pennsylvania; D011446:Prospective Studies; D011787:Quality of Health Care / Q000592:standards*; D017216:Telemedicine; D013997:Time Factors; D014741:Video Recording