No room for error: Standardizing operating room to pediatric critical care unit handoffs through quality improvement

Handoffs from the operating room to the pediatric critical care unit are a high-risk transition in care. Communication failures during this process may compromise patient safety and continuity of care, particularly in pediatric surgical patients who are often medically complex and require coordinated multidisciplinary care. This study aimed to assess the success of a standardized operating room-to-pediatric critical care unit handoff protocol.

This quality improvement project used a prepost design. Baseline data included audits of operating room-to-pediatric critical care unit handoffs and multidisciplinary provider surveys. The findings informed the development of a standardized handoff protocol. Postimplementation evaluation included additional handoff audits and a follow-up provider survey. Comparative analyses assessed changes in handoff structure, communication, and team perceptions.

One hundred handoffs were audited (50 preimplementation, 50 postimplementation). After implementation, team attendance increased (71.4% vs 96.0%, P = .0029), provider introductions increased (14.0% vs 63.2%, P < .0001), and closed-loop communication rose from 10.0% to 96.0% (P < .0001). Key information transfer improved, including reporting of procedure (78.0% vs 100.0%), intraoperative findings (65.3% vs 98.0%), and anticipated complications (54.0% vs 94.0%). Handoff organization improved (32.0% vs 90.0%) with more opportunities for questions (48.0% vs 94.0%). Provider surveys demonstrated high satisfaction with the protocol (84.8%).

Implementation of a standardized multidisciplinary operating room-to-pediatric critical care unit handoff protocol improved communication, completeness of information, and provider satisfaction. Standardized perioperative handoffs represent a feasible quality improvement strategy to reduce variability and enhance safety during high-risk postoperative transfers in pediatric surgical patients.