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Improving Postoperative Handoff in a Surgical Intensive Care Unit
Deborah A Talley1, Eleanor Dunlap2, Dawn Silverman2
1Deborah A. Talley, Eleanor Dunlap, Dawn Silverman, and Stephanie Katzer are acute care nurse practitioners in the surgical intensive care unit, University of Maryland Medical Center, Baltimore, Maryland. Meredith Huffines is a senior clinical nurse II in the surgical intensive care unit, University of Maryland Medical Center. Cindy Dove is Director of Nursing for Surgery and Cardiac Surgical Services, University of Maryland Medical Center. Megan Anders is an anesthesiologist and Associate Chair for Safety and Quality, Department of Anesthesiology, University of Maryland Medical Center. Samuel M. Galvagno is an associate professor and Associate Medical Director, surgical intensive care unit, University of Maryland Medical Center, and Associate Chief Medical Officer, Maryland Critical Care Network, Baltimore. He is a colonel in the US Air Force and Director of Critical Care Air Transport Team operations, 943rd Aerospace Medicine Squadron, Davis-Monthan Air Force Base, Arizona. Samuel A. Tisherman is Medical Director, surgical intensive care unit, surgical intermediate care unit, and the Center for Critical Care and Trauma Education, University of Maryland Medical Center dschwartz2@umm.edu.
Background:
Evidence-based research demonstrates that postoperative formalized handoff improves communication and satisfaction among hospital staff members, leading to improved patient outcomes.
Objective:
To improve postoperative patient safety in the surgical intensive care unit of a tertiary academic medical center.
Methods:
A verbal and written formal reporting method was designed, implemented, and evaluated. The intervention created an admission "time-out," allowing the handoff from surgical and anesthesia teams to the intensive care unit team and bedside nurses to occur in a more structured manner. Before and 1 year after implementation of the intervention, nurses completed surveys on the quality of postoperative handoff.
Results:
After the intervention, the proportion of nurses who reported receiving handoff from the surgical team increased from 20% to 60% (P < .001). More nurses felt satisfied with the surgical handoff (46% before vs 74% after the intervention; P < .001), and more nurses frequently felt included in the handoff process (42% vs 74%; P < .001). Nurses perceived improved communication with surgical teams (93%), anesthesia teams (89%), and the intensive care unit team (94%), resulting in a perception of better patient care (88%).
Conclusion:
After implementation of a systematic multidisciplinary handoff process, surgical intensive care nurses reported improved frequency and completeness of the postoperative handoff process, resulting in a perception of better patient care.
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