Sustainability of protocolized handover of pediatric cardiac surgery patients to the intensive care unit.

Publisher: Arnette-Blackwell Country of Publication: France NLM ID: 9206575 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1460-9592 (Electronic) Linking ISSN: 11555645 NLM ISO Abbreviation: Paediatr Anaesth Subsets: MEDLINE

Original Publication: Paris, France : Arnette-Blackwell, c1991-

Cardiac Surgical Procedures/*methods ; Critical Care/*organization & administration ; Intensive Care Units, Pediatric/*organization & administration ; Patient Handoff/*standards; Checklist ; Child ; Clinical Protocols ; Continuity of Patient Care ; Forms and Records Control ; Humans ; Medical Errors ; Operating Rooms/organization & administration ; Perioperative Care/standards ; Prospective Studies ; Tertiary Care Centers

Background: Transfer of patient care among clinicians (handovers) is a common source of medical errors. While the immediate efficacy of these initiatives is well documented, sustainability of practice changes that results in better processes of care is largely understudied.
Aims: The objective of the current investigation was to evaluate the sustainability of a protocolized handover process in pediatric patients from the operating room after cardiac surgery to the intensive care unit.
Methods: This was a prospective study with direct observation assessment of handover performance conducted in the cardiac ICU (CICU) of a free-standing, tertiary care children's hospital in the United States. Patient transitions from the operating room to the CICU, including the verbal handoff, were directly observed by a single independent observer in all phases of the study. A checklist of key elements identified errors classified as: (1) technical, (2) information omissions, and (3) realized errors. Total number of errors was compared across the different times of the study (preintervention, postintervention, and the current sustainability phase).
Results: A total of 119 handovers were studied: 41 preintervention, 38 postintervention, and 40 in the current sustainability phase. The median [Interquartile range (IQR)] number of technical errors was significantly reduced in the sustainability phase compared to the preintervention and postintervention phase, 2 (1-3), 6 (5-7), and 2.5 (2-4), respectively P = 0.0001. Similarly, the median (IQR) number of verbal information omissions was also significantly reduced in the sustainability phase compared to the preintervention and postintervention phases, 1 (1-1), 4 (3-5) and 2 (1-3), respectively.
Conclusions: We demonstrate sustainability of an improved handover process using a checklist in children being transferred to the intensive care unit after cardiac surgery. Standardized handover processes can be a sustainable strategy to improve patient safety after pediatric cardiac surgery.
(© 2016 John Wiley & Sons Ltd.)

Keywords: cardiac; handover; pediatric; surgery; sustainability

Date Created: 20160322 Date Completed: 20170102 Latest Revision: 20220330

20221213

10.1111/pan.12878

26997082