SESSION TITLE: Patient Safety Initiatives
SESSION TYPE: Original Investigation Slide
PRESENTED ON: Wednesday, October 29, 2014 at 07:30 AM - 08:30 AM
PURPOSE: Ineffective communication is the leading cause of medical errors. Handoff between shifts represents a risk for miscommunication. This has led to increased interest in developing an effective standardized handoff process. However, there is little evidence on what constitutes a good handoff, especially in the Intensive Care Unit (ICU). We sought to characterize the existing handoff practice in an academic, tertiary care center.
METHODS: We conducted serial observations on handoffs at shift changes in a mixed medical-surgical ICU at Rochester Methodist Hospital in Rochester, Minnesota. We design an observation tool to assess handoff content. The tool was piloted and refined through several Plan-do-study-act (PDSA) cycles to ensure reliability. The final tool achieved a Cohen’s Kappa coefficient 0.88 across all items. We performed several observations of the handoff process using this tool. The details of the handoffs were documented and timed.
RESULTS: During December of 2013, we observed 14 shift changes involving 40 unique patients with 92 handoffs total. Both incoming and outgoing teams included an attending physician, a critical care fellow and a nurse practitioner (NP) or physician assistant (PA). The presenters during the handoffs were fellows in 52% and nurse practitioners in 37% of cases. The content of the handoffs were as follows: The chief complaint was identified in 99%, code status in 9%, not being mentioned in 91% of cases. The ventilation mode was discussed in 65%, medication infusions in 59%, antibiotics in 28% of appropriate cases, and a list of “things-to-do” in 61% of events. Contingencies (“if/then” recommendations) were discussed in 28%, and questions were asked by the incoming team in 52% of cases. The bedside nurse directly participated in 48 (52%) handoffs and disposition was discussed in 51 (55%) cases. A mean of 2.90 minutes (SD ±1.82 min) was spent discussing each patient, the fellow spending an average of 2.74 min (SD ±1.94 min) (Table 1).
CONCLUSIONS: These results highlight the complexity and current variability of the handoff process in the ICU. The lack of standardization demonstrated represents an opportunity to streamline this very important process. An analysis of the sequence of information as well as the data that constitutes the most effective handoff is also needed.
CLINICAL IMPLICATIONS: Understanding the current practice of handoff process in the intensive care unit will allows us to target an unique oportunity to improve patient safety.
DISCLOSURE: The following authors have nothing to disclose: Ronaldo Sevilla Berrios, Carlos Racedo Africano, Sumedh Hoskote, Andrea Braun, John OHoro, Kimberly Bryant, Theodore Loftsgard,, Nathan Smischney, Vivek Iyer
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