The Role of Standardizing the White's Fast Track Handoff From Operating Room to Postanesthesia Care Unit: A Quality Improvement Project.

Optimizing communication during patient handoff is essential to reduce errors and provide quality patient care. The purpose of this quality improvement project was to standardize handoffs between the operating room (OR) and the postanesthesia care unit (PACU) based on a revised White's Fast Track Score (WFTS) handoff tool.This project design included second and third plan-do-study-act (PDSA) cycles on improving the WFTS tool and its use. The first cycle modified the WFTS, the second cycle measured sustainability, and the third cycle introduced further revisions to the tool. Based on feedback, the tool was reinforced with a memory aid, keyword prompts, and training. Functionality and OR and PACU nursing satisfaction with revisions were then assessed.Fidelity to the handoff process was observed in PDSA 2. Revisions to the WFTS were then made, with training sessions conducted for OR and PACU nurses, followed by the implementation of the revised handoff tool in PDSA 3. Satisfaction surveys were administered.Compliance with the WFTS handoff elements significantly improved in PDSA Cycle 3 (M = 85%, standard deviation [SD] = 20%) compared to PDSA Cycle 2 (M = 48%, SD = 8%), U = 55.00, Z = -4.83, P less than .001. Specific elements such as anesthesia details, level of consciousness, hemodynamic stability, and respiratory stability, which were previously reported infrequently, showed notable increases in documentation. Staff satisfaction among OR nurses remained neutral, with median scores of 2 across all survey items. However, PACU nurses' satisfaction was more positive, indicating an improvement in the perceived quality of information transfer. Qualitative feedback highlighted ongoing challenges, including redundant information and workflow inefficiencies.The revised handoff tool implemented in PDSA 3 significantly improved compliance with essential communication elements but introduced perceived workflow inefficiencies and redundancy. To enhance adoption and usability, it is recommended to differentiate required elements based on case complexity, reduce redundant reporting, address workflow barriers, and increase frontline nursing engagement in the revision process. Balancing standardization with efficiency is crucial for optimizing postoperative handoff communication.

Duke Scholars

Author Remi M Hueckel School of Nursing

Author Emily Funk School of Nursing