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Promoting a Culture of Safety in the Pediatric ICU by Improving the Quality of Postoperative Handoffs FREE TO VIEW

Christopher Carroll, MD; Kathleen Sala, MPH; Andrea Benin, MD
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Connecticut Children's Medical Center, Hartford, CT

Chest. 2013;144(4_MeetingAbstracts):406A. doi:10.1378/chest.1698777
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SESSION TITLE: Quality Improvement in the ICU II

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Tuesday, October 29, 2013 at 04:30 PM - 05:30 PM

PURPOSE: Handoffs are a recognized potential source of medical errors and play an important role in patient safety. Improving the quality of handoffs between the operating room (OR) and the intensive care unit (ICU) is particularly important, as the high complexity and instability of the patient population can lead to a higher risk of medical errors. Our aim was to determine if we could intervene to improve the quality of handoffs in children admitted to the ICU postoperatively.

METHODS: Intervention: A structured handoff tool was developed using a multidisciplinary approach, which included key participants and a checklist of critical steps. Beginning in May 2012, this tool was instituted for children admitted to the ICU post-operatively. Evaluation: Compliance with key steps was audited in real time using a checklist. Data regarding clinical characteristics and outcomes of the patients were collected and the AHRQ Hospital Survey on Patient Safety Culture was administered.

RESULTS: Between May 2012 and January 2013, 205 children were admitted to the ICU post-operatively. Overall, handoffs were performed 94% of the time; ranging from 82% in May to 100% starting in August. Attendance by key providers ranged from 37% to 100% and there was 100% compliance with critical steps in the conducted handoffs. Surgical subspecialty, time of return from OR, and ICU length of stay were not associated with frequency of attendance or compliance with handoff. Written positive comments were reported in 15% of handoffs; there were no negative comments. Seventy staff members in the ICU completed the safety culture survey (96% response rate); 67% of respondents disagreed with the statement “problems often occur in the exchange of information across hospital units” in contrast with 42% (446/1063) for the hospital overall (P<.001), 13% (2/15) on the previous year’s survey in the ICU (P<.001) and 44% for the overall AHRQ benchmark.

CONCLUSIONS: Use of structured handoff tools for children admitted to the ICU post-operatively is feasible and well received by staff.

CLINICAL IMPLICATIONS: Improving handoffs in the ICU may play a successful part in promoting a culture of safety and enhancing communication.

DISCLOSURE: The following authors have nothing to disclose: Christopher Carroll, Kathleen Sala, Andrea Benin

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