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Adaptation of a postoperative handoff communication process for children with heart disease: a quantitative study
Jerome Gene Chen1, Melanie C Wright, Phillip Brian Smith
1Duke University Medical Center, Durham, NC, USA. jgenechen@floridapediatrics.com
Insights
Pediatric cardiac surgery handoffs from operating room to intensive care unit showed significant gaps in protocol adherence. User-centered adaptations highlight the need for improved communication interventions and reduced distractions.
Area of Science:
- Medicine
- Healthcare Management
- Patient Safety
Background:
- Handoff communication is critical for patient safety, yet vulnerable to information loss.
- An institutional protocol was implemented in 2005 to enhance operating room to intensive care unit handoffs for pediatric cardiac surgery patients.
Purpose of the Study:
- To assess the current state of handoff communication after pediatric cardiac surgery.
- To understand how users adapt a communication intervention over time.
Main Methods:
- A cross-sectional study observing 29 handoff events.
- Data collection on participant presence, content reporting rates, and environmental distractions.
Main Results:
- High attendance (97%) but low average content reporting rate (53%).
- Higher reporting rates for non-protocol items like echocardiogram results (68%) and vascular access (79%).
- An average of 2.3 environmental distractions per minute were recorded.
Conclusions:
- User-driven modifications indicate the importance of user-centered innovation in process improvement.
- Future interventions should minimize distractions and include anticipated patient course discussions.
Abstract:
Handoff communication is a point of vulnerability when valuable patient information can be inaccurate or omitted. An institutional protocol was implemented in 2005 to improve the handoff from the operating room to the intensive care unit after pediatric cardiac surgery. A cross-sectional study of the present process was performed to understand how users adapt a communication intervention over time. Twenty-nine handoff events were observed. Individuals required for the handoff were present at 97% of the events. Content items averaged a 53% reporting rate. Some clinical information not specified in the protocol demonstrated a higher reporting rate, such as echocardiogram results (68%) and vascular access (79%). A mean of 2.3 environmental distractions per minute of communication were noted. Participant-directed adjustments in content reporting suggest that a facilitator in process improvement is user-centered innovation. Future handoff communication interventions should reduce nonessential distractions and incorporate a discussion of the anticipated patient course.
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