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Leveraging Telemedicine Infrastructure to Monitor Quality of Operating Room to Intensive Care Unit Handoffs
Mark E Barry1, Beth R Hochman, Meghan B Lane-Fall
1M.E. Barry is a medical student, Division of Traumatology, Surgical Critical Care, and Emergency Surgery, Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania. B.R. Hochman is assistant professor, Division of Acute Care Surgery, Department of Surgery, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, New York. M.B. Lane-Fall is assistant professor, Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, and senior fellow, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania. D. Zappile is acute care nurse practitioner, Division of Traumatology, Surgical Critical Care, and Emergency Surgery, Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania. D.N. Holena is assistant professor, Division of Traumatology, Surgical Critical Care, and Emergency Surgery, Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, and senior fellow, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania. B.P. Smith is assistant professor, Division of Traumatology, Surgical Critical Care, and Emergency Surgery, Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania. L.J. Kaplan is associate professor, Division of Traumatology, Surgical Critical Care, and Emergency Surgery, Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania. A. Huffenberger is director of operations, Penn E-lert Telemedicine Program, University of Pennsylvania Health System, Philadelphia, Pennsylvania. P.M. Reilly is chief and professor, Division of Traumatology, Surgical Critical Care, and Emergency Surgery, Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania. J.L. Pascual is associate professor, Division of Traumatology, Surgical Critical Care, and Emergency Surgery, Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
Operating room to intensive care unit (OR-to-ICU) handoff quality is similar on nights/weekends versus weekdays. Existing telemedicine technology can evaluate these critical patient transitions effectively.
Area of Science:
- Healthcare quality improvement
- Medical education technology
- Patient safety research
Background:
- Effective patient handoffs are crucial for patient safety, especially during transitions from the operating room (OR) to the intensive care unit (ICU).
- Assessing the quality of these handoffs, particularly during non-peak hours like nights and weekends, presents unique challenges.
Purpose of the Study:
- To compare the tempo and quality of team interactions during OR-to-ICU handoffs on nights/weekends versus weekdays.
- To demonstrate the utility of existing telemedicine technology for evaluating handoff quality.
Main Methods:
- A prospective observational study was conducted in a surgical ICU.
- In-room video recordings of OR-to-ICU handoffs were obtained using telemedicine cameras.
- Evaluators used adapted, validated measures to assess various quality indicators, including teamwork, communication, and professionalism.
Main Results:
- No significant differences were found in basic handoff characteristics between weekdays and nights/weekends.
- Most quality measures were similar across both time frames.
- Surgeons showed improved report delivery and engagement during night/weekend handoffs, while OR anesthesiologists' performance remained consistent.
Conclusions:
- A novel approach using telemedicine infrastructure can effectively assess OR-to-ICU handoff quality.
- Handoff quality during nights and weekends is comparable, and sometimes superior, to weekdays.
- Video analysis offers a valuable, unobtrusive method for quality improvement, education, and policy compliance in patient handoffs.
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