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Standardizing postoperative PICU handovers improves handover metrics and patient outcomes
Ryan K Breuer1, Brad Taicher, David A Turner
11Division of Pediatric Critical Care Medicine, Department of Pediatrics, Duke Children's Hospital, Duke University Medical Center, Durham, NC. 2Division of Pediatric Anesthesia, Department of Anesthesia, Duke Children's Hospital, Duke University Medical Center, Durham, NC.
Insights
Implementing a standardized handover protocol significantly improved communication and patient outcomes for postoperative admissions to a pediatric intensive care unit (PICU). This enhanced care was sustained over time, demonstrating the protocol's long-term effectiveness.
Area of Science:
- Medical Informatics
- Patient Safety
- Quality Improvement
Background:
- Effective communication during patient handovers is critical for ensuring patient safety and optimizing outcomes, particularly in high-acuity settings like the pediatric intensive care unit (PICU).
- Suboptimal handover processes can lead to communication breakdowns, medical errors, and adverse patient events, necessitating structured interventions.
Purpose of the Study:
- To enhance handover communication among multidisciplinary teams for postoperative admissions to a pediatric intensive care unit (PICU).
- To evaluate the impact of a standardized handover protocol on patient outcomes and identify sustained improvements over time.
Main Methods:
- A prospective cohort study was conducted in a multidisciplinary PICU at a university hospital.
- An online survey identified handover barriers, guiding the development of a standardized protocol.
- Direct observations of postoperative PICU admissions pre- and post-protocol implementation, with follow-up observations at 12 months, assessed communication, metrics, and patient outcomes.
Main Results:
- Provider ratings of handover attendance, communication, and quality significantly increased post-protocol implementation (p < 0.001).
- Surgical report errors were eliminated, and provider attendance during handovers increased from 39.3% to 68.2% (p = 0.01).
- Adverse events decreased, with fewer patients experiencing antibiotic delays (34.5% to 13.9%; p = 0.03) or requiring hemodynamic/respiratory interventions (24.6% to 9.1%; p = 0.04), and faster initiation of analgesia and laboratory studies.
Conclusions:
- Implementation of a standardized handover protocol effectively improves postoperative communication and patient outcomes in the PICU.
- The positive effects on communication, patient safety, and efficiency were sustained at the 12-month follow-up, highlighting the protocol's lasting impact.
Objectives:
To improve handover communication and patient outcomes for postoperative admissions to a multidisciplinary PICU.
Design:
Prospective cohort study.
Setting:
Multidisciplinary PICU in a university hospital.
Subjects:
The multidisciplinary team responsible for postoperative PICU admissions and patient care, including attending, fellow, house staff physicians, and nurses from pediatric critical care medicine, surgery, and anesthesia.
Interventions:
An online survey distributed to PICU, surgery, and anesthesia providers identified existing barriers and challenges to effective postoperative PICU handovers and guided the formation of a standard protocol. Handovers for postoperative PICU admissions were then directly observed for 3 months pre- and postimplementation of the protocol, with data collected on communication, metrics, and patient outcomes. Observations and data collection, as well as the online provider survey, were repeated approximately 1 year after handover protocol implementation.
Measurements And Main Results:
Survey data demonstrated increases in provider ratings of handover attendance, communication, and quality after implementation of the handover protocol (p < 0.001). Surgical report errors were eliminated (p = 0.03), and the prevalence of provider attendance for the handover duration increased from 39.3% to 68.2% (p = 0.01). Following protocol implementation, fewer patients experienced antibiotic delays (34.5% to 13.9%; p = 0.03) or required hemodynamic or respiratory interventions within the first 6 hours of PICU admission (24.6% to 9.1%; p = 0.04). Patients received their first dose of analgesia (62.3 to 17.4 min; p = 0.01) and had their admission laboratory studies sent (42.3 to 32.9 min; p = 0.04) more quickly. Data collected at 12 months postimplementation demonstrated sustained reductions in analgesia timing, antibiotic delays, and handover barriers.
Conclusions:
Postoperative communication and patient outcomes can be improved and sustained over time with implementation of a standardized handover protocol.
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