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Standardizing postoperative PICU handovers improves handover metrics and patient outcomes.

Publication ,  Journal Article
Breuer, RK; Taicher, B; Turner, DA; Cheifetz, IM; Rehder, KJ
Published in: Pediatr Crit Care Med
March 2015

OBJECTIVES: To improve handover communication and patient outcomes for postoperative admissions to a multidisciplinary PICU. DESIGN: Prospective cohort study. SETTING: Multidisciplinary PICU in a university hospital. SUBJECTS: The multidisciplinary team responsible for postoperative PICU admissions and patient care, including attending, fellow, house staff physicians, and nurses from pediatric critical care medicine, surgery, and anesthesia. INTERVENTIONS: An online survey distributed to PICU, surgery, and anesthesia providers identified existing barriers and challenges to effective postoperative PICU handovers and guided the formation of a standard protocol. Handovers for postoperative PICU admissions were then directly observed for 3 months pre- and postimplementation of the protocol, with data collected on communication, metrics, and patient outcomes. Observations and data collection, as well as the online provider survey, were repeated approximately 1 year after handover protocol implementation. MEASUREMENTS AND MAIN RESULTS: Survey data demonstrated increases in provider ratings of handover attendance, communication, and quality after implementation of the handover protocol (p < 0.001). Surgical report errors were eliminated (p = 0.03), and the prevalence of provider attendance for the handover duration increased from 39.3% to 68.2% (p = 0.01). Following protocol implementation, fewer patients experienced antibiotic delays (34.5% to 13.9%; p = 0.03) or required hemodynamic or respiratory interventions within the first 6 hours of PICU admission (24.6% to 9.1%; p = 0.04). Patients received their first dose of analgesia (62.3 to 17.4 min; p = 0.01) and had their admission laboratory studies sent (42.3 to 32.9 min; p = 0.04) more quickly. Data collected at 12 months postimplementation demonstrated sustained reductions in analgesia timing, antibiotic delays, and handover barriers. CONCLUSIONS: Postoperative communication and patient outcomes can be improved and sustained over time with implementation of a standardized handover protocol.

Duke Scholars

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Published In

Pediatr Crit Care Med

DOI

ISSN

1529-7535

Publication Date

March 2015

Volume

16

Issue

3

Start / End Page

256 / 263

Location

United States

Related Subject Headings

  • Prospective Studies
  • Practice Guidelines as Topic
  • Postoperative Period
  • Pediatrics
  • Patient Transfer
  • Patient Handoff
  • Patient Care Team
  • Patient Admission
  • Male
  • Intensive Care Units, Pediatric
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Breuer, R. K., Taicher, B., Turner, D. A., Cheifetz, I. M., & Rehder, K. J. (2015). Standardizing postoperative PICU handovers improves handover metrics and patient outcomes. Pediatr Crit Care Med, 16(3), 256–263. https://doi.org/10.1097/PCC.0000000000000343
Breuer, Ryan K., Brad Taicher, David A. Turner, Ira M. Cheifetz, and Kyle J. Rehder. “Standardizing postoperative PICU handovers improves handover metrics and patient outcomes.Pediatr Crit Care Med 16, no. 3 (March 2015): 256–63. https://doi.org/10.1097/PCC.0000000000000343.
Breuer RK, Taicher B, Turner DA, Cheifetz IM, Rehder KJ. Standardizing postoperative PICU handovers improves handover metrics and patient outcomes. Pediatr Crit Care Med. 2015 Mar;16(3):256–63.
Breuer, Ryan K., et al. “Standardizing postoperative PICU handovers improves handover metrics and patient outcomes.Pediatr Crit Care Med, vol. 16, no. 3, Mar. 2015, pp. 256–63. Pubmed, doi:10.1097/PCC.0000000000000343.
Breuer RK, Taicher B, Turner DA, Cheifetz IM, Rehder KJ. Standardizing postoperative PICU handovers improves handover metrics and patient outcomes. Pediatr Crit Care Med. 2015 Mar;16(3):256–263.

Published In

Pediatr Crit Care Med

DOI

ISSN

1529-7535

Publication Date

March 2015

Volume

16

Issue

3

Start / End Page

256 / 263

Location

United States

Related Subject Headings

  • Prospective Studies
  • Practice Guidelines as Topic
  • Postoperative Period
  • Pediatrics
  • Patient Transfer
  • Patient Handoff
  • Patient Care Team
  • Patient Admission
  • Male
  • Intensive Care Units, Pediatric