Author + information
- Pooja Nawathe,
- Nicole Berndsen,
- Veena Sivarajan,
- Vincent Olshove,
- Ken Catchpole and
- Alistair Phillips
Background: Coordination among units, staff and equipment for a congenital cardiac surgical patient requires a strategic process. Structured handoff processes enhance teamwork, communication and patient outcomes. Transitioning patients from the operating room (OR) to the congenital cardiac intensive care unit (CCICU) is a critical time to relay what transpired during the peri-operative course. The handoff process was developed for seamless communication, and enhancement of coordination of care amongst the team.
Methods: This was a prospective, interrupted time series observational study, in the CCICU. Two observers evaluated handoff process based on occurrence, flow and clinical disruptions. Flow and clinical disruptions include 5 different categories scored zero to five. Clinically significant events were evaluated at 6 and 24 hours.
Results: The study included 29 patients. Two defined groups were used, Group 1 (Gp1); n=16 prior to establishing a handoff process and Group 2 (Gp2); n=13 after the establishment of the handoff process. Completion of handoff was significantly less in Gp2 (mean 23.5 mins ±8, median 20 min), vs. Gp1 (mean 33.5±14, median 32.5). Flow disruptions showed no significant difference although cut in half (mean Gp1=1.5, mean Gp2= 0.8, p= 0.12). With the handoff process in place, treatment errors 6 hours post-operatively had a significant reduction (mean Gp1= 0.8, mean Gp2= 0.2, p= 0.02). Disruption in handoff occurred frequently due to equipment problems in both groups (Gp1 43.8%, Gp2 38.5%), while logistical problems reduced in Gp2 (Gp1 50%, Gp2 0%). There was enhanced handoff use (31.3% vs. 7.7%), decreased hemodynamic instability at 6 hours post-operatively (18.8% vs. 0%), reduction in drug errors (12.5% vs.7.7%).
Conclusions: By using quality improvement methodology to design and implement a new direct OR-CCICU structured multidisciplinary verbal handoff, we achieved improvements in patient safety and efficiency. Handoff communication was enhanced, with fewer errors and content omissions. The new process improved communication and goal alignment amongst the team members.
Poster Hall, Hall C
Friday, March 17, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Congenital Heart Disease: Advances in Quality Improvement for Pediatric Cardiac Care
Abstract Category: 10. Congenital Heart Disease: Pediatric
Presentation Number: 1143-020
- 2017 American College of Cardiology Foundation