Improving postoperative handover: a prospective observational study

doi:10.1016/j.amjsurg.2013.03.005

The American Journal of Surgery

Volume 206, Issue 4, October 2013, Pages 494-501

https://doi.org/10.1016/j.amjsurg.2013.03.005 Get rights and content

Abstract

Background

The information provided during the postoperative handover influences the delivery of care of patients in the postoperative recovery unit through their care on the ward. There is a need for a structured and systematic approach to postoperative handover. The aim of this study was to improve postoperative handover through the implementation of a new handover protocol, which involved a handover proforma and standardization of the handover process.

Methods

This prospective pre-post intervention study demonstrated the improvement in postoperative handover through standardization. There was a significant reduction in information omissions and task errors and improvement in communication and teamwork with the new handover protocol.

Results

There was a significant reduction in overall information omissions from 9 to 3 (P < .001) omissions per handover and task errors from 2.8 to .8 (P < .001) with the new handover protocol. Teamwork and nurses' satisfaction score significantly improved from a median of 3 to 4 (P < .001) and median of 4 to 5 (P < .001). Duration of handover decreased from a median of 8 to 7 minutes (P < .376).

Conclusions

The study demonstrates that standardization of postoperative handover improved communication and teamwork and reduced information omissions and task errors. There was an improvement in the quality of the handover after the introduction of the new handover protocol, which was easy and simple to use.

Section snippets

Methods

This was a prospective pre–post intervention study with direct observation of handover conducted in the PACU of an acute teaching hospital in London. A total of 90 handovers were evaluated by a trained researcher, 50 before and 40 after the introduction of a new handover protocol. Handovers of patients who had undergone major vascular (n = 41) and major gastrointestinal (n = 49) surgical procedures were observed. Operative patients included 55 males and 35 females, with a median age of 64

Interrater reliability

The interrater reliability calculated by Spearman correlation was found to be significant (ρ = .964, P < .001).

Information omissions

After the new handover protocol, there was a significant reduction in the number of information omissions per handover, from 9 to 3 (P < .001) (Fig. 1). The largest reduction in information omissions per handover was observed for surgical information, which decreased from 4.2 to .8 (P < .001). Information omissions per handover of both patient-specific information 2.6 to 1.3 (P < .001)

Comments

The new handover protocol produced a marked improvement in the quality of handover. Information omissions and task errors were significantly reduced and there was considerable improvement in teamwork and nurse satisfaction scores. In fact, improvements were found across almost the entire process following its introduction. The structured approach to the transfer of information from operating theater staff to recovery staff and coordination of tasks performed contributed to the improved teamwork

Conclusions

Despite any potential failings, implementation of the new handover protocol significantly improved the quality of the postoperative handover through enhanced information transfer, teamwork, and reduced task errors. In most health care settings, the handover in the PACU is the conduit to information downstream when patients are transferred to their final recovery facility. By improving postoperative handover in the PACU, we can ensure that information transferred downstream is made more

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Cited by (58)

Bringing a Multiteam Systems Perspective to the Perioperative Context: Considerations for Future Research of Perioperative Handoffs
2023, Joint Commission Journal on Quality and Patient Safety
Perioperative handoffs entail transferring responsibility for surgical patients from one specialized group or team to another. Multiteam system (MTS) theory has not yet been considered within perioperative handoff literature, even though multiple teams must work within and across the preoperative, intraoperative, and postoperative settings to care for shared patients.
Using a case study from gynecological oncology, the authors demonstrate the applicability of an MTS taxonomy to the perioperative context. Compositional, linkage, and developmental MTS attributes are defined, along with the concept of boundary spanning, using examples from the case study to illustrate their relevance to the perioperative environment. Key research issues invoked through the application of the MTS taxonomy are discussed alongside overarching recommendations regarding approaches and methods to study these issues.
This discussion of perioperative handoffs considers team functional diversity and motivation, between-team interdependence and communication patterns, changes in MTS composition and structure, and boundary spanning. The authors make overarching recommendations for future research that specify mapping perioperative MTSs, identifying weaknesses in MTS functioning and possible handoff design countermeasures, and evaluating handoffs designs’ impact on patient care and MTS outcomes using several study designs.
An MTS perspective can uniquely inform key research questions to advance the practice of perioperative handoffs. Processes that affect complex patient safety and care quality outcomes demand consideration of between-team collaboration quality during perioperative periods. The application of MTS theory in intervention research addressing perioperative handoffs can support MTS functioning for the benefit of safe, high-quality care.
Structured perioperative team communication
2023, Handbook of Perioperative and Procedural Patient Safety
Communication among care team members perioperatively is crucial to the success of the operation and the safety of the patient. Effective communication facilitates teamwork during the operation, helps transfer information during transitions, and creates a collaborative work environment. This chapter will summarize the importance of perioperative team communication and outline methodologies including the mandated surgical time-out, the expanded surgical time-out, surgical checklists, pre- and postoperative briefings, and handoffs to the next level of care. We will summarize the literature regarding outcomes and perceptions of each of these communication systems. Finally, we will provide a framework and tools for how to implement these communication strategies.
Bedside handover with structured and relayed forms in a postanesthesia care unit: A pre- and post-implementation study
2022, Applied Nursing Research
Early postoperative patients are vulnerable. Poor communication between health care professionals may seriously damage patients' wellbeing. There is a risk of information loss when bedside handover is performed.
To investigate whether the implementation of structured and relayed forms to shift-to-shift bedside handovers improve the frequency of appropriate handover elements and reduces the incidence of adverse events and postoperative length of stay for patients in a postanesthesia care unit.
This quality improvement project was conducted in a postanesthesia care unit of a tertiary stomatological hospital in China. The study population was patients under surveillance in the postanesthesia care unit for >12 h. A pre- and post-implementation approach was employed. The pre-implementation of unstructured bedside handovers and the post-implementation of bedside handovers with structured and relayed forms were compared. The indicators measured were appropriate handover elements, adverse patient events, and postoperative hospital stay.
There were 387 and 395 morning handovers observed pre- and post-implementation of bedside handovers with structured and relayed forms, respectively. Of the 21 elements that should be delivered, 17 elements were noted to be improved. No improvement was found in the incidence of adverse events and postoperative hospital stay.
Bedside handovers with structured and relayed forms increased the incidence of appropriate handover elements. The use of structured and relayed forms did not affect on the incidence of adverse events and postoperative hospital stay. Individualized relayed handover forms may be developed and implemented according to the characteristics in which they are administered.
Assessment of postoperative patient handover practice and safety at post anesthesia care unit of Dilla University Referral Hospital, Ethiopia: A cross-sectional study
2022, Annals of Medicine and Surgery
Good handover creates a common understanding of responsibility and patients’ status. To proceed with effective handover process, effective communication between healthcare providers plays a vital role. But, it is commonly observed that there is ineffective communication between health care providers and it increases the risk of medical errors and negatively affects the quality of care, patient outcome and satisfaction. In addition, the transfer of care after surgery to the postanesthesia care unit (PACU) presents special challenges to providers on both the delivering and receiving teams.
A descriptive cross-sectional study was conducted at post anesthesia care unit of Dilla University Referral Hospital from October 1 to November 30, 2020. To conduct the study, consecutively selected 208 handovers of patients from operation theatre (OT) to PACU were assessed. A checklist was developed based on a combination of criteria adopted from the Australian Medical Association 2006 and British Doctors Committee 2004. It was pilot tested and changes were made before the actual data collection.
Our study found that the postoperative patient handover practice among professionals was poor (below 50%) in the areas of patients’ full name, age, medical registration number (MRN), ASA class, allergic history, medical history, baseline vital signs, preoperative diagnosis and surgical procedure performed. Our study also found poor postoperative hand overing regarding the intraoperative blood loss 9.6%, intraoperative clinical incidents 5.3%, recovery condition 7.2%, postoperative analgesia plan 18.8%, and post operative antibiotic plan 8.2%. Whereas, type of anesthesia 81.3%, intraoperative vital signs 80.8%, and intraoperative analgesia used 79.8%, intraoperative fluid management 80.8% were among the indicators with >50% completion rate.
Our study found a poor practice of patient handover regarding sociodemographic and preoperative profile, anesthesia, surgery and other necessary information. We believe standardizing this process and providing training will improve the quality of postoperative handovers and the safety of patients during this critical period.
Translation and Psychometric Assessment of the Postoperative Handover Assessment Tool
2021, Journal of Perianesthesia Nursing
The objective of the present study was to translate and validate the Postoperative Handover Assessment Tool (PoHAT) in the Persian language.
The study used a descriptive, mixed-method design.
The present descriptive, mixed-method study was conducted in 2018 at Shahid Rajaee Hospital and Shiraz Nursing and Midwifery School, Shiraz University of Medical Sciences (Shiraz, Iran), to evaluate the psychometric properties of the Persian version of the PoHAT. The original version of PoHAT was translated into the Persian language and then back-translated for comparison. The face validity (qualitative), content validity (qualitative and quantitative), construct validity (experimental intervention method), and reliability (inter-rater reliability, internal consistency) of the Persian version of the PoHAT were assessed. Data were analyzed using SPSS software, version 22. P values less than 0.05 were considered statistically significant.
The content validity ratio of all the 34 items of the Persian version of the PoHAT ranged between 0.66 and 1. The content validity index for all items was within the acceptable range (between 0.92 and 1). The result of construct validity, using the experimental intervention method, showed a significant difference between before and after intervention (P < .05). The correlation coefficient for inter-rater reliability of all subscales (information, tasks, teamwork) and the total checklist was 0.89, 0.80, 0.94, and 0.85, respectively; the coefficient was significant for all subscales (P < .001).
The validity and reliability of the 34-item Persian version of the PoHAT were confirmed. The application of the PoHAT to assess the process and quality of postoperative handover in Iran and other Persian-speaking countries is recommended.
Challenges Associated With Patient Transfer From Postanesthesia Care Unit to Surgical Unit in Iran: A Mixed-Method Study
2021, Journal of Perianesthesia Nursing
This study aimed to explore the entire spectrum of challenges associated with the process of patient transfer from the postanesthesia care unit (PACU) to the surgical unit.
The study employed a mixed-method design with concurrent triangulation approach.
The study was conducted during July-December 2018 at three teaching hospitals affiliated to Shiraz University of Medical Sciences, Shiraz, Iran. A total of 23 health-care providers involved with the patient transfer process from the PACU and surgical unit were recruited. Data were collected using quantitative and qualitative approaches. The quantitative study included 25 structured observations. The qualitative study included 12 unstructured observations, individual semistructured in-depth interviews (n = 13), and focused group sessions (n = 3). Data were managed using MAXQDA.10 software and analyzed using SPSS software (version 22.0).
Based on qualitative data, 4 main categories and 14 subcategories were extracted. The main categories were “Multifarious Activities of Nurses”, “Insufficient Organizational Resources”, “Task-oriented Approach”, and “Deficient Professional Performance”. Results showed that 51% of patient-specific information, 64% of anesthesia information, and 74% of surgical information was not transferred during patient handoffs.
Insufficient organizational resources and deficient professional performance were identified as the main challenges associated with the transfer process of postoperative patients. Our findings provide a better understanding of these challenges and encourage health policymakers and planners to resolve these issues to promote patient safety during handoffs.

View all citing articles on Scopus

The authors declare no conflicts of interest.

This research was supported by the Health Foundation, National Institute of Health Research (NIHR) and the UK Engineering and Physical Sciences Research Council (EPSRC).

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Clinical ScienceImproving postoperative handover: a prospective observational study

Abstract

Background

Methods

Results

Conclusions

Section snippets

Methods

Interrater reliability

Information omissions

Comments

Conclusions

Passing the buck: clinical handovers at a tertiary hospital

N Z Med J

The patient handover: a study of its form, function and efficiency

Nurs Stand

How many health professionals does a patient see during an average hospital stay?

N Z Med J

Medical errors involving trainees: a study of closed malpractice claims from 5 insurers

Arch Intern Med

Communication during post-operative patient handoff in the pediatric intensive care unit

Crit Care Med

Improving the complex nature of care transitions

J Nurs Care Qual

Surgeon information transfer and communication: factors affecting quality and efficiency of inpatient care

Ann Surg

Recovery room incidents: a review of 419 reports from the Anaesthetic Incident Monitoring Study (AIMS)

Anaesthesia

Clinical Science
Improving postoperative handover: a prospective observational study