TY - JOUR
T1 - An observational study of postoperative handoff standardization failures
AU - Abraham, Joanna
AU - Meng, Alicia
AU - Sona, Carrie
AU - Wildes, Troy
AU - Avidan, Michael
AU - Kannampallil, Thomas
N1 - Funding Information:
We would like to thank all clinicians for their participation. Work included in this manuscript was partly produced with the support of the Big Ideas Program, a BJC HealthCare and Washington University School of Medicine internal grant program , hosted by the Healthcare Innovation Lab and the Institute for Informatics.
Publisher Copyright:
© 2021 Elsevier B.V.
PY - 2021/7
Y1 - 2021/7
N2 - Background: Patient handoffs from an operating room (OR) to an intensive care unit (ICU) require precise coordination among surgical, anesthesia, and critical care teams. Although several standardized handoff strategies have been developed, their sustainability remains is poor. Little is known regarding factors that impede handoff standardization. Purpose: Our objectives are three-fold: (1) highlight compliance failures with standardized handoffs; (2) identify factors contributing to compliance failures; and (3) develop guidelines for sustainable handoff interventions and processes. Methods: We used ethnographic data collection methods—general observations, handoff shadowing, and semi-structured clinician interviews—with 84 participants from OR, ICU, and telemedicine teams at a large academic medical center. We conducted thematic analysis supported by inductive and deductive coding using the Systems Engineering Initiative for Patient Safety (SEIPS) framework. Results: Post-operative handoffs can be characterized into four phases: pre-transfer preparation, transfer and setup, report preparation and delivery, and post-transfer care. We identified compliance failures with standardized handoff protocols and associated risk factors within the OR-ICU work system including limited teamwork, absence of handoff-specific tools, and poor clinician buy-in. To improve handoffs, clinicians provided suggestions for developing collaborative Electronic Health Record (EHR)-integrated handoff tools and re-engineering the handoff process. Conclusions: Compliance failures are prevalent in all handoff phases, leading to poor adherence with standardization. We propose theoretically grounded guidelines for designing “flexibly standardized” bundled handoff interventions for ensuring care continuity in OR to ICU transitions of care.
AB - Background: Patient handoffs from an operating room (OR) to an intensive care unit (ICU) require precise coordination among surgical, anesthesia, and critical care teams. Although several standardized handoff strategies have been developed, their sustainability remains is poor. Little is known regarding factors that impede handoff standardization. Purpose: Our objectives are three-fold: (1) highlight compliance failures with standardized handoffs; (2) identify factors contributing to compliance failures; and (3) develop guidelines for sustainable handoff interventions and processes. Methods: We used ethnographic data collection methods—general observations, handoff shadowing, and semi-structured clinician interviews—with 84 participants from OR, ICU, and telemedicine teams at a large academic medical center. We conducted thematic analysis supported by inductive and deductive coding using the Systems Engineering Initiative for Patient Safety (SEIPS) framework. Results: Post-operative handoffs can be characterized into four phases: pre-transfer preparation, transfer and setup, report preparation and delivery, and post-transfer care. We identified compliance failures with standardized handoff protocols and associated risk factors within the OR-ICU work system including limited teamwork, absence of handoff-specific tools, and poor clinician buy-in. To improve handoffs, clinicians provided suggestions for developing collaborative Electronic Health Record (EHR)-integrated handoff tools and re-engineering the handoff process. Conclusions: Compliance failures are prevalent in all handoff phases, leading to poor adherence with standardization. We propose theoretically grounded guidelines for designing “flexibly standardized” bundled handoff interventions for ensuring care continuity in OR to ICU transitions of care.
KW - Communication
KW - Compliance
KW - Patient transfer
KW - Safety
KW - Surgical patients
UR - http://www.scopus.com/inward/record.url?scp=85104930307&partnerID=8YFLogxK
U2 - 10.1016/j.ijmedinf.2021.104458
DO - 10.1016/j.ijmedinf.2021.104458
M3 - Article
C2 - 33932762
AN - SCOPUS:85104930307
SN - 1386-5056
VL - 151
JO - International Journal of Medical Informatics
JF - International Journal of Medical Informatics
M1 - 104458
ER -