Improving the neonatal team handoff process in a level IV NICU: reducing interruptions and handoff duration

Neonatal intensive care unit (NICU) patients are at increased risk for handoff communication failures due to complexity and prolonged length of stay. We report a quality initiative aimed at reducing avoidable interruptions during neonatal handoffs while monitoring handoff duration and provider satisfaction.

Observational time series between August 2015 and March 2018 in an academic level IV NICU. NICU I-PASS and process changes were implemented using plan-do-study-act cycle, and statistical process control charts were used in the analysis. Unmatched preintervention and postintervention satisfaction surveys were compared using Mann-Whitney U tests.

There was special cause variation in the mean number of avoidable interruptions per handoff from 4 to 0.3 (92% reduction). The mean duration of handoff was reduced ~1 min/patient. Provider satisfaction with the quality of handoffs also improved from a mean of 3.36 to 3.75 on a 1-5 Likert scale (p=0.049).

Standardisation of NICU handoff with NICU I-PASS and process changes led to the sustained reduction in avoidable interruptions with the added benefit of reduced handoff length and improved provider satisfaction.