Using Intraoperative Trauma Video Review to Assess Emergency Department to Operating Room Handoffs in Surgical Trauma...

Emergency department (ED) to operating room (OR) handoffs for injured patients requiring operative intervention represent a critical junction in patient care. Numerous models and checklists have been developed to guide an effective handoff, but studying adherence is challenging secondary to a lack of available data sources. In 2024, our center initiated an intraoperative trauma video review program as part of our quality improvement efforts, effectively providing a granular source of data to study this issue. We sought to describe variability in the timing and content of ED-to-OR handoffs, focusing on components being underutilized. Our hypothesis is that handoffs are shorter and less comprehensive in hemodynamically unstable patients.

Using consecutive audiovisual recordings of ED-to-OR handoffs occurring from June to August 2024 in a dedicated trauma OR, we analyzed the occurrence and timing of handoff elements in our institutional Trauma Anesthesia Checklist (TAC). The checklist delineates the procedures that should occur before the patient enters the room, at the time of patient arrival, and upon induction of anesthesia. This study focused specifically on TAC handoff elements that should occur at the time of patient arrival to the OR. We scored each handoff element based on whether it was clearly verbalized during the handoff and then calculated rates of utilization for each element.

We abstracted 43 cases over 12 wk. Hypotension was present in 12 (28%) of cases. Handoffs had a median duration of 36 s (interquartile range 21-47 s). The median number of handoff elements verbalized was six of possible 18 (interquartile range 4-8), with mechanism and extent of injury being the most common element verbalized (81.4%). There was a small but significant relationship between length of handoff and number of elements verbalized (B = 3.7 (95% CI 0.78-6.58 s, P = 0.014). The presence of hypotension was significantly associated only with verbalization of the massive transfusion protocol domain of the TAC (Fully or partially verbalized in 7 (58.3%) hypotensive versus 2 (6.6%) nonhypotensive patients, (P = 0.001).

ED-to-OR handoffs are often incomplete at our center and represent an opportunity for improvement. Completeness of handoffs was largely unaffected by patient hypotension. Intraoperative trauma video review can be used to measure critical processes that occur in emergent surgical cases for trauma.