Better Outcomes Seen With Standardized Handoff Protocol

by Alison McCook

Handovers of patients during surgery are associated with an increased risk for mortality, but use of a standardized protocol might help lower that risk, according to new research presented at the 2011 annual meeting of the Society of Cardiovascular Anesthesiologists. Christopher Hudson, MD, staff anesthesiologist at the University of Ottawa Heart Institute, in Canada, and his colleagues found that when care of a patient passed from one anesthesiologist to another during cardiac surgery, the patient’s risk for dying in the hospital was 2.2 times higher (abstract 67). Patients who underwent handover also were 55% likelier to experience major morbidity, including heart attack or stroke.

To address potential errors that can occur when a patient is transferred from the operating room to postoperative care, Michelle Petrovic, MD, assistant professor of anesthesiology and critical care medicine, Johns Hopkins University School of Medicine, in Baltimore, and her colleagues implemented a pilot protocol that included explicit handover instructions. “Traditionally, this has been done very quickly at all institutions across the country,” Dr. Petrovic said, “and we are trying to change the culture.”

As part of the protocol, key members of the team must be present during the handoff, including the surgeon, the anesthesiologist and the receiving nurse and clinician. “That in itself is a big culture change,” Dr. Petrovic said. All members must be present for a formal report guided by an information checklist in which each member runs through key information such as the patient’s medical history and what occurred during surgery; this is followed by a question and answer session. There is also a formal end to the handoff, in which the team members explicitly announce when the handover is complete.

To determine whether the new system improved the process, Dr. Petrovic and her colleagues observed 60 handovers, half of which took place after the protocol was implemented. The presence of all members of the handoff team at the handoff increased from zero at baseline to nearly 70%. Handoffs in which information in the surgery report was missed declined from 26% to 16%. Handoffs in which there was a failure to pass on information in the anesthesia report did not decrease with use of the protocol, remaining at about 18%. Handoffs lasted approximately two minutes longer when the protocol was followed, but the change was not statistically significant.

Despite the risks associated with handover, these exchanges also are an opportunity to enhance the outcome, Dr. Hudson said. “A new anesthesiologist will bring fresh eyes, and so may even improve what’s going on,” he said.

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