Perioperative handoffs are critical transition points for safety and quality of care. Any communication barrier or breakdown has the potential to impact patient outcomes.
Every clinician should be concerned that all relevant information is transferred accurately from the sending practitioner to the receiving practitioner. This exchange is particularly important when the patient is critically ill or returning from major surgery.
Recognizing this crucial period, The Joint Commission Journal on Quality and Patient Safety dedicated a special issue in August to original studies and commentaries on perioperative handoffs.
One of the articles highlighted in the issue is a study from the Perelman School of Medicine at the University of Pennsylvania in Philadelphia, detailing the creation and implementation of the Handoffs and Transitions in Critical Care (HATRICC), which involves a standardized protocol for handoffs from the operating room to the intensive care unit (ICU).
The study, which was conducted 2014 to 2017, used fuzzy-set qualitative comparative analysis (fsQCA) to characterize combinations of conditions associated with fidelity to the HATRICC protocol. Conditions were derived from postintervention handoff observations yielding quantitative and qualitative data.
Fifty handoff observations were analyzed; at the individual handoff episode level, four conditions explained high fidelity to the HATRICC protocol:
- Patient was newly admitted to the ICU
- Presence of an ICU provider
- Observer-rated attention paid by the handoff team
- Handoff took place in a quiet environment
While the researchers determined that none of the conditions was solely needed or sufficient for high fidelity, three combinations of those conditions equated to viable pathways for fidelity to HATRICC protocols and explained 93.5% of cases demonstrating high fidelity:
- Presence of the ICU provider and high-attention ratings
- Newly admitted patient, presence of the ICU provider, and quiet environment
- Newly admitted patient, high-attention ratings, and quiet environment
Other articles in the special issue of the Journal included:
- A study on bringing a multiteam system theory (MTS) perspective to the perioperative context. The authors demonstrated the applicability of an MTS taxonomy to the perioperative context using a case study from gynecological oncology.
- A study attempting to improve a process for cardiovascular handoffs by applying human factors and the science of teamwork. The team used Plan-Do-Study-Act cycles and participatory design and ergonomics to create, use, and measure a new handoff process and bundle.
- Literature reviews on strategies to improve handoff and on possible ways to leverage technology and artificial intelligence to enhance handoffs.
- A systematic review of the peer-reviewed literature focused on handoff studies with education interventions that included anesthesiology providers.
- A commentary on taking a resilience engineering approach to perioperative handoffs.
In an editorial titled, “Improving Perioperative Handoffs: Moving Beyond Standardized Checklists and Protocols,” Joanna Abraham, PhD, and coauthors reflected on the articles featured in the special issue and discussed the need to go beyond standardizing elements of an effective handoff and address possible contextual factors unique to the types of handoffs and care settings.
“Large-scale adoption and reach of evidence-based handoff strategies should consider the core principles of implementation science,” Dr. Abraham and coauthors wrote. “Using mixed methods (qualitative, quantitative) measurement systems will be essential to detect and understand the influence of handoff barriers and enablers on implementation strategies and outcomes.”
Disclaimer
The thoughts and opinions expressed in this column are solely those of Dr. Jacobs and do not necessarily reflect those of The Joint Commission or the American College of Surgeons.
