STEPP IN: A Multicenter Quality Improvement Collaborative Standardizing Postoperative Handoffs

Anthony J. Piazza, Beverly Brozanski, Theresa Grover, John Chuo, Teresa Mingrone, Rakesh Rao, Joan Smith, Doreen Soliman, Natalie Rintoul, Bobby Bellflower, Troy Richardson, Margaret Holston, Richard McClead, Judy Guidash, Eugenia K. Pallotto

Research output: Contribution to journalArticlepeer-review

Abstract

OBJECTIVE: To reduce care failures by 30% through implementation of standardized communication processes for postoperative handoff in NICU patients undergoing surgery over 12 months and sustained over 6 months. METHODS: Nineteen Children's Hospitals Neonatal Consortium centers collaborated in a quality improvement initiative to reduce postoperative care failures in a surgical neonatal setting by decreasing respiratory care failures and all other communication failures. Evidence-based clinical practice recommendations and a collaborative framework supported local teams' implementation of standardized postoperative handoff communication. Process measures included compliance with center-defined handoff staff presence, use of center-defined handoff tool, and the proportion of handoffs with interruptions. Participant handoff satisfaction was the balancing measure. Baseline data were collected for 8 months, followed by a 12-month action phase and 7-month sustain phase. RESULTS: On average, 181 postoperative handoffs per month were monitored across sites, and 320 respondents per month assessed the handoff process. Communication failures specific to respiratory care decreased by 73.2% (8.2% to 4.6% and with a second special cause signal to 2.2%). All other communication care failures decreased by 49.4% (17% to 8.6%). Eighty-four percent of participants reported high satisfaction. Compliance with use of the handoff tool and required staff attendance increased whereas interruptions decreased over the project time line. CONCLUSIONS: Team engagement within a quality improvement framework had a positive impact on the perioperative handoff process for high-risk surgical neonates. We improved care as demonstrated by a decrease in postoperative care failures while maintaining high provider satisfaction.

Original languageEnglish
JournalPediatrics
Volume148
Issue number6
DOIs
StatePublished - Dec 1 2021

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