Utilizing a Standardized Handoff Initiative Incorporating Both Medical Clearance Postoperative Recommendations and...

Area of Science:

• Quality Improvement
• Healthcare Informatics
• Orthopaedic Surgery

Background:

• Patients undergoing total joint arthroplasty (TJA) with multiple comorbidities require clear medical clearance recommendations.
• Failure to adhere to these recommendations can result in adverse postoperative complications.
• Effective information transfer between providers is crucial for managing complex TJA patients.

Purpose of the Study:

• To assess the impact of a standardized handoff process on information transfer for TJA patients.
• To incorporate medical clearance postoperative recommendations and orthopaedic-specific context into the handoff.
• To improve the quality of care and reduce postoperative complications in TJA.

Main Methods:

• A systematic review of studies from 2014-2019 identified best practices for standardized handoff processes.
• A quality improvement initiative was implemented, including baseline chart audits and stakeholder input.
• A structured "smart phrase" was developed and integrated into the electronic health record, incorporating medical clearance and orthopaedic context.

Main Results:

• Baseline handoff of medical clearance recommendations was 42%; post-implementation, the smart phrase was used 97-100%.
• Medical clearance recommendations were captured in 83% of cases post-intervention.
• The standardized handoff ensured communication of wound closure, precautions, and void status, projecting cost savings of $0.69 per case.

Conclusions:

• A standardized handoff smart phrase, including specialty-specific context and medical management requirements, significantly improved information transfer.
• This initiative enhanced communication between providers in an academic orthopaedic setting.
• The improved information transfer is expected to lead to better patient outcomes and cost efficiencies.