Transitions in Critical Care: Evaluating the Implementation of a Handover Tool for Postoperative Cardiac Surgery Patients
CCCF ePoster library. Denomme J. Nov 8, 2018; 233344
Justine Denomme
Justine Denomme
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Abstract
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Introduction: Accurate and efficient handover is critical in the transfer of postoperative surgical patients by anesthesiology to the cardiac intensive care unit (CVICU). A systematic review of postoperative handover identified an association between the quality of patient handover and patient harm1. One strategy to improve handover and prevent adverse events is the application of checklists to standardize communication and minimize omissions2. Our academic centre recently implemented a standardized handover tool for the transfer of postoperative cardiac surgery patients to the CVICU.


 

Objectives: To assess completion of a novel handover tool 6-months post-implementation, and elicit attitudes and perceptions of anesthesiologists and members of the CVICU team about perioperative patient handover.


 

Methods: Ethics review was completed via the local REB. Chart review began 6-months post-implementation of the handover tool and included 373 consecutive patients who underwent cardiac surgery over a 3-month period. Completion of the 59 parameters on the handover tool was assessed for adherence, and compared to the anesthetic record and preoperative investigations to assess for quality and accuracy of information. Using an online database, a self-administered survey was created regarding perioperative handover of CVICU patients. The survey was pilot tested and broadly disseminated to all cardiac anesthesiologists as well as healthcare professionals working in the CVICU. Questions were designed using a 5-point Likert scale with opportunity for free text commentary.


 

Results: 357 (96%) of the charts reviewed included a copy of the handover tool. The parameters most frequently completed (>80% of charts) included medical history, airway management, arterial lines, cardiac bypass duration, drug dosing, and the transferring anesthesiologist's name. Documentation regarding pacing, recent bloodwork, central lines, peripheral IVs, and time of transfer were completed in less than 80% of charts. The response rate to the survey was 111 of 154 stakeholders (72%). 72% of respondents felt the handover tool improved the handover process and 62% felt it improved handover efficiency.  No respondents felt the tool worsened handover. The majority felt the tool improved the transfer of important details of intraoperative care. The tool also enhanced verbal communication by anesthesiology trainees, standardized handover among anesthesia providers, and allowed access to important perioperative details after handover was completed. Barriers to success of the handover tool included a lack of awareness of its existence and nominal completion. Barriers to the effectiveness of overall patient transition included: insufficient clearance of physical space during patient transfer, lack of attendance of the cardiac surgeon and ICU attending during handover, and difficulty hearing verbal handover at the bedside.





Conclusions: The introduction of a handover tool for cardiac surgical patients has improved handover from the perspective of its users, and continues to be used with promising adherence 6-months post-implementation.  It is a useful resource detailing important patient and surgical information, and continues to be used even after verbal handover was completed. Barriers to effective transition of patients into the ICU with high-quality handover were identified and can be targeted for continuous quality improvement interventions.


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