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Standardized multidisciplinary protocol improves handover of cardiac surgery patients to the intensive care unit*

Joy, Brian F. MD; Elliott, Emily RN, MSN, CPNP; Hardy, Courtney MD; Sullivan, Christine MBA, MS; Backer, Carl L. MD; Kane, Jason M. MD, MS

Pediatric Critical Care Medicine: May 2011 - Volume 12 - Issue 3 - pp 304-308
doi: 10.1097/PCC.0b013e3181fe25a1
Cardiac Intensive Care

Objectives: To determine whether the implementation of a standardized handover protocol could reduce the number of errors occurring during patient transitions from the operating room to the intensive care unit.

Design: Prospective, interventional study.

Setting: Pediatric cardiac intensive care unit.

Subjects: Seventy-nine patient handovers in patients transitioning from the operating room to the cardiac intensive care unit after congenital cardiac surgery.

Interventions: A preintervention assessment of patient handovers was obtained by direct observation using a standardized checklist. A teamwork-driven handover process and protocol was developed using traditional and novel quality-improvement techniques. The postimplementation observational assessment of handovers was performed using the same preintervention assessment tool. Preintervention and postintervention data metrics were analyzed and compared.

Measurements and Main Results: Forty-one and 38 observations were performed in the preintervention and postintervention periods, respectively. Protocol implementation improved key areas of the handover process. Technical errors per handover were reduced from 6.24 to 1.52 (p < .0001), and critical verbal handoff information omissions were reduced from 6.33 to 2.38 (p < .0001) per handover. There was no change in duration of either the verbal handoff briefing or the overall handover process. Caregivers noted improvement in teamwork and handoff content received after the intervention.

Conclusions: A formal, structured handover process for pediatric patients transitioning to the intensive care unit after cardiac surgery can reduce medical errors that occur during the admission process and improve teamwork among caregivers.

From the Division of Pediatric Critical Care (BFJ, JMK), Pediatric Cardiothoracic Surgery (EE, CLB), and Pediatric Anesthesia (CH), Northwestern University, Feinberg School of Medicine, Chicago, IL; and Children's Memorial Hospital, Children's Memorial Research Center (CS), Chicago, IL.

The authors have not disclosed any potential conflicts of interest.

For information regarding this article, E-mail: bjoy@childrensmemorial.org

©2011The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies