coaching operating room to pacu handoff with a

Purpose

To pilot a standardized multidisciplinary bedside handoff for any patient admitted to the post-anesthesia care unit (PACU) from the operating room.

Introduction

• Breakdown in communication has been attributed to 70% of sentinel adverse events.

• Studies suggest education and implementation of a standardized beside handoff checklist may improve transitions of care may.

• We successfully implemented a handoff process from the operating room to the surgical intensive care unit (SICU) at our institution in 2018 using the Team STEPPS I-PASS framework.

• Inspired by their experience with the SICU handoff process, the PACU Nursing Council at our institution expressed interest in implementing a similar I-PASS checklist for more consistent, multidisciplinary handoffs from the operating room to PACU teams.

Methods

• Multidisciplinary group comprised of surgery, nursing, and anesthesia representatives developed an I-PASS handoff checklist for patients admitted from the operating room to PACU.

• We performed a pre-pilot survey to characterize clinician attitudes on the current handoff process.

• We provided training to surgery residents and fellows, anesthesia residents, certified registered nurse anesthetists (CRNA), and nurses at departmental meetings and piloted the process with all general surgery patients.

• We performed direct observations over a two-week period to identify compliance with handoff components and make adjustments to the handoff checklist tool to meet the needs of all team members.

Results

• 19 direct observations over 2 weeks• 7 operative services• Average duration: 152 seconds or 2.5 minutes• All teams present: 19/19• Nursing engagement: 18/19• Delays/pauses: 5/19 • Redirections: 5/19• Handoff Tool was revised based feedback from nurses

and surgery residents.

Next Steps

• We plan to perform a post-pilot survey to obtain feedback on the new process.

• We will then provide education to the other surgical departments to implement the OR to PACU handoff process with these additional teams.

Conclusion

• The pre-pilot survey showed a need for a standardized handoff process for patients being admitted to the PACU from the OR.

• The current pilot study demonstrated the feasibility of a multidisciplinary handoff for postoperative patients admitted to the PACU.

Coaching Operating Room to PACU Handoff with a Standardized, Multidisciplinary ChecklistCourtney L. Devin, MD1; Kathleen Grife, RN, MS1,2; Marissa Weber, MD2; Richard F. Schmidt, MD3; Megan P. Lundgren, MD1; Scott W. Cowan, MD1

1Department of Surgery, Thomas Jefferson University Hospital 2Department of Anesthesiology, Thomas Jefferson University, 3Department of Neurosurgery, Thomas Jefferson University Hospital Hospital

Pre-Intervention Survey

Operating Room to PACU Handoff Tool

Organized Efficient Comprehensive SafeAll Responses 21.98% 35.56% 15.38% 23.08%Nurses 14.29% 22.86% 11.43% 17.14%Surgery Residents 11.11% 25.71% 5.56% 13.89%Anesthesia Residents 58.33% 91.67% 25.00% 41.67%CRNAs 50.00% 50.00% 62.50% 62.50%

Plans are relayed

Cooperation between OR + PACU

Satisfied with current status

All Responses 21.74% 43.96% 19.57%Nurses 17.14% 25.71% 5.71%Surgery Residents 27.78% 50.00% 19.44%Anesthesia residents 0.00% 50.00% 33.33%CRNAs 44.44% 87.50% 55.56%