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Quality of handover in a pediatric postanesthesia care unit
Florian Piekarski1, Jost Kaufmann2, Michael Laschat2
1Medical Faculty of Health, Witten/Herdecke University, Witten, Germany.
Insights
Pediatric anesthetic handovers to the postanesthesia care unit (PACU) are often incomplete, lacking crucial patient safety information. A standardized protocol is needed to improve communication quality in pediatric anesthesia care.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Patient Safety
Background:
- Anesthetic handovers to postanesthesia care units (PACU) are suboptimal in adults.
- Limited data exists on the quality and content of pediatric anesthetic handovers.
- This study addresses the gap in understanding pediatric handover communication.
Purpose of the Study:
- To investigate the presence and consistency of handover components in pediatric PACU.
- To identify critical information gaps in pediatric anesthetic handovers.
Main Methods:
- Prospective observational study of 443 pediatric PACU handovers.
- Utilized a detailed 55-item checklist to evaluate information transmission.
- Compared verbally transmitted information against written anesthesia records.
Main Results:
- Surgery type and intraoperative regional anesthesia were frequently communicated.
- Critical information like ASA-PS and fluid management was rarely included.
- Only 11 out of 55 checklist items were consistently communicated (>70% of cases).
Conclusions:
- Pediatric anesthetic handovers to PACU are frequently incomplete.
- Omission of essential data poses a risk to patient safety.
- A standardized, mandatory handover protocol for pediatric anesthesia is essential.
Background:
The quality of anesthetic handovers to postanesthesia care units (PACU) is known to be poor in adults, and only very limited reports are available regarding the quality of handovers in pediatric anesthesia. In particular, it is not known which and in what quality information is communicated. This current study investigated, therefore, the presence of any handover component as well as its consistency in a pediatric postanesthesia care unit.
Methods:
This prospective observational study evaluated postoperative anesthetic handovers to a pediatric PACU using a detailed checklist, comprising 55 possible items. The main outcome measure was the proportion of information verbally transmitted in relation to the written documentation within the anesthesia record.
Results:
Four hundred and forty-three handovers were observed with two handovers excluded due to missing data. Type of surgery (93% [95% CI 91-95]) and any intra-operative regional anesthesia (89% [95% CI 85-94]) were most frequently communicated. Items such as ASA-PS (3% [95% CI 2-5]) and fluid management (4% of cases [95% CI 2-6]) were rarely handed over. Eleven of the 55 items contained within the checklist were communicated in more than 70% of patients.
Conclusions:
The observed handovers to PACU staff were incomplete and missing important information. However, omission of essential information potentially compromises patient safety. A standardized universal mandatory handover protocol following pediatric anesthesia is required.
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