patient handoff report for surgical patients

What are the limitations of patient handoffs?

Patient handoffs: Delivering content efficiently and effectively is not enough. [Int J Risk Saf Med. 2012] Patient handoffs: Delivering content efficiently and effectively is not enough.

Why are there so many handoffs during surgery?

These changes in procedure and location lead to multiple handoffs between anesthesia, surgical, nursing, and technical staff, and often require additional team members who may not have been part of the initial preoperative handoff and, therefore, will likely have limited information regarding the patient.

What is an operating room to postoperative handoff?

Operating Room to Post Anesthesia Care Unit (PACU) Postoperative handoffs are the most common and well-studied handoffs in the field of anesthesiology. These typically involve anesthesia staff reporting to PACU nursing staff and may also involve surgical team members.

Are perioperative handoffs associated with patient outcomes?

Nonetheless, several published papers about perioperative handoffs suggest that these handoffs are associated with patient outcomes, including adverse events, major morbidity, and mortality.

What should a handoff report include?

Nurses complete their handoff report with evaluations of the patient's response to nursing and medical interventions, the effectiveness of the patient-care plan, and the goals and outcomes for the patient. This category also includes evaluation of the patient's response to care, such as progress toward goals.

What is included in the handoff report to the surgical nursing staff?

Holding room handoffs usually involve information transfer between the patient or family member, a holding room nurse, an operating room (OR) nurse, an anesthesia team member, and may or may not include a surgical team member. The quality and content of the information communicated varies significantly.

What should not be included in patient handoff?

Handoff is not a comprehensive communication of every detail of the patient's history or clinical course. Avoid passing on all possible information in an effort to be comprehensive. Too much data may mask or bury the important nuggets that the next provider needs. Don't list every medication the patient is on.

What is patient handoff?

A hand-off is a transfer and. acceptance of patient care. responsibility achieved through. effective communication.

What should be included in change of shift report?

It should include the patient's medical history, current medication, allergies, pain levels and pain management plan, and discharge instructions. Providing these sorts of details about your patient in your end of shift report decreases the risk of an oncoming nurse putting the patient in danger.

What is a nursing handoff report?

Nurse bedside shift report, or handoff, has been defined in the literature as a process of exchanging vital patient information, responsibility, and accountability between the off-going and oncoming nurses in an effort to ensure safe continuity of care and the delivery of best clinical practices.

How do I improve my handoff report?

How to Improve Hand Off Communication In Nursing for Better Patient HandoffsIdentify the Various Types of Handoffs Your Organization Makes, and the Requirements for Each One. ... Establish Best Practices Around Patient Handoffs. ... Create and Communicate Handoff Protocols that Meet Patient, Provider, and Employee Needs.More items...•

Why is hand off report important?

Most importantly, communication supports the foundation of patient care. So, hand-off reporting during shift change is a critical process that is crucial in protecting a patient's safety. Throughout the hand-off report, it is vital to provide accurate, up-to-date, and pertinent information to the oncoming nurse.

What is SBAR handoff?

Situation, Background, Assessment, Recommendation (SBAR) is a mnemonic used to structure information sharing to avoid communication failures during handoffs.

What are patient care reports?

The primary purpose of the Patient Care Report (PCR) is to document all care and pertinent patient information as well as serving as a data collection tool. The documentation included on the PCR provides vital information, which is necessary for continued care at the hospital.

What should be included in a nursing handover?

What goes in to a handover?Past: historical info. The patient's diagnosis, anything the team needs to know about them and their treatment plan. ... Present: current presentation. How the patient has been this shift and any changes to their treatment plan. ... Future: what is still to be done.

What is handoff and types of handoff?

There are two types of handoffs − Hard Handoff − In a hard handoff, an actual break in the connection occurs while switching from one cell to another. The radio links from the mobile station to the existing cell is broken before establishing a link with the next cell. It is generally an inter-frequency handoff.

What is the role of a nurse in a change of shift?

The nurse notifies the physician and obtains correct and complete medication orders, thereby avoiding a potentially serious medication error. A nursing unit schedules staffing coverage to accommodate the shift change and minimize the occurrence of interruptions during change-of-shift report.

What does Nurse Green realize about morphine sulfate?

When Nurse Brown asks about this, Nurse Green realizes she gave morphine sulfate but did not document it on the MAR. Due to Nurse Brown’s question, Nurse Green realizes the omission and communicates the information and documents it in the medical record , preventing an accidental overdose of a medication.

What is a handoff in healthcare?

A handoff may be described as the transfer of patient information and knowledge, along with authority and responsibility, from one clinician or team of clinicians to another clinician or team of clinicians during transitions of care across the continuum.

Why are handoffs important?

Patient handoffs are a necessary component of current medical care. Accurate communication of information about a patient from one member of the health care team to another is a critical element of patient care and safety; it is also one of the least studied and taught elements of daily patient care.

What are the barriers to the effective transfer of vital information?

Ineffective organization of the information by the sender and lack of attention by the receiver are two significant barriers to the effective transfer of vital information. Structured forms of communication, such as the Situation-Background-Assessment-Recommendation (also referred to as SBAR) technique, should be considered. Communication may be verbal, written, or both 8. The Joint Commission requires that staff use a record and read-back process before taking action on a verbal order or verbal report of a critical test result 3. Verbal communication includes a face-to-face conversation or a telephone call. Face-to-face exchange of information is generally the preferred form of verbal communication because it allows direct interaction among those present. Not only may questions be asked and answered, but also further nonverbal information may be expressed by body language and facial expression. Written communication may assist the person conveying clinical information in organizing his or her thoughts and presenting important details. It also allows the receiving party to have a paper-generated or computer-generated hard copy of information for reference. However, written communication lacks the subjective interpersonal aspect of verbal communication. The most effective handoff of patient information includes both verbal and written components 9.

What is the physical environment of a nursing station?

Physical Environment. The physical environment in which the interaction takes place may hinder effective communication. For example, a noisy nursing station is a less desirable setting for communicating handoff information than a quiet conference room located away from other distractions. Having discussions in an environment without distractions ...

What role does a senior physician play in the health care team?

Senior physicians should also serve as role models for attentive listening and the elicitation of concerns from other team members.

Is there a protocol for handoffs?

Although there is no universally accepted protocol for all of the information that a written handoff should contain , there are several key elements that should be present in any transfer of patient care, whether oral or written.

Is voice mail considered a handoff?

E-mail may constitute an appropriate form of handoff if receipt is acknowledged. Voice mail or other unacknowledged messages, however, do not constitute an acceptable form of handoff. Both patient handoffs and ongoing clinical communication can be improved to promote high-quality medical care.

What is postoperative handoff?

Postoperative handoffs are the most common and well-studied handoffs in the field of anesthesiology. These typically involve anesthesia staff reporting to PACU nursing staff and may also involve surgical team members. In studies of routine postoperative handoffs, it was found that significant amounts of information were frequently missed, such as ASA status, antibiotics received, and fluid administration. 17 Handoffs of ambulatory patients also commonly resulted in omission of data and resulted in poor receiver satisfaction. 18 Composites of overall handoff quality are judged to be “good” less than half of the time following patient delivery to the PACU, 19 and the variable quality of communication of pertinent case events in most postoperative handoffs is associated with a perceived increase in complication rates. 13,20 As for claims data, 14% of anesthesia-related PACU issues were attributed to failures or deficiencies in communication. 4#N#As noted above, structured handoffs in a pediatric population have been shown to significantly decrease communication errors and increase reliability and effectiveness of communication in the OR, and also in the PACU. 14 Nagpal also reported a decrease in information omission and task errors and an increase in staff satisfaction after institution of a standardized handoff tool. 12 Another study showed that a multimodal intervention substantially improved PACU handoffs, and the effect continued to be present 3 years after the intervention. 21 Overall, the data available supports the use of a structured approach to postoperative handoff that includes a tool and education about its use.

What is a handoff in nursing?

Handoffs, in the most concise description, are an exchange of responsibility for one or more patients from one provider to another . Handoffs are “conversations rather than reports” 1 and typically consist of four phases—preparation (by both parties), patient arrival in the new location, the actual handoff (e.g., RN-MD interaction), ...

What is an ICU handoff?

OR to ICU handoffs often include anesthesiology and surgical team members, OR nursing, and ICU team members, which may include physicians, nurse practitioners, physician assistants, nursing staff, respiratory therapists, and others. In some cases, the handoff from the operating room to the ICU may be the first structured handoff in a patient’s hospital course, especially in emergency situations. Although many of these studies have limitations, standardized ICU handoffs may be associated with reduced long-term ICU complications. 22

Where do patients begin their operative course?

Most patients begin their operative course in a holding room, where they typically encounter pre-operative nursing, anesthesia providers, and their surgical team. The preoperative handoff thus begins in the holding room; yet little information exists on these preoperative interactions. Holding room handoffs usually involve information transfer between the patient or family member, a holding room nurse, an operating room (OR) nurse, an anesthesia team member, and may or may not include a surgical team member. The quality and content of the information communicated varies significantly.

Is intraoperative handoff rushed?

However, the intraoperative handoff is often rushed, conversational, and not well-structured.

Do patients come to the OR from holding rooms?

Patients do not always arrive to the OR from a holding room. They may come to the OR from any number of locations, such as the emergency department, a medical/surgical floor, or the intensive care unit (ICU), either directly or via the holding room. The variability in culture in these locations presents its own challenges and barriers, as each location may have different preparation techniques prior to OR transfer. Team composition, policies, charting, and methods of communication may differ from unit to unit. In addition, there may be limited information available due to the emergent nature of some procedures. In a study of neonatal intensive care unit (NICU) to OR handoffs, several barriers to information exchange were discovered. 7 These included lack of a standardized report, lack of patient preparation for transfer, unclear transition of care between team members, unclear provider roles, significant provider traffic in and out of the room, and distractions or interruptions. Not only do the providers present at the time of handoff vary widely, but up to 10 different providers were present at any given handoff. In addition, the perception of handoff quality varied widely between NICU providers (MDs, RNs, NPs) and anesthesia providers (MDs, CRNAs, RNs), with 41% reporting “fair” to “poor” and only 35% reporting “very good” to “excellent.” Caruso and colleagues suggested that standardizing ICU to OR handoffs increased communication without delaying surgery and improved anesthesia provider satisfaction scores. 8

Is handoff from the operating room to the ICU the first structured handoff?

In some cases, the handoff from the operating room to the ICU may be the first structured handoff in a patient’s hospital course, especially in emergency situations. Although many of these studies have limitations, standardized ICU handoffs may be associated with reduced long-term ICU complications. 22.

What are the two aspects of perioperative handoffs?

While there is evidence supporting perioperative handoff standardization, there are at least two largely unaddressed aspects of perioperative handoffs. First, we do not know which standardization strategies are most useful. Published studies to date have compared one standardized process to the lack of a process, but have not compared two or more standardization strategies to each other. Second, we know very little about the implementation strategies that are effective in adopting and adhering to standardized handoffs. Clearly, there can be no true improvement in patient outcomes, even with the best standardized process, if the process is not adopted and durably followed by the clinicians responsible for patient care. For this reason, future studies require attention to implementation strategy. Implementation strategies that might be tested include customizing standardized handoffs to local clinicians’ needs, developing leadership buy-in, stakeholder engagement and involvement in intervention development, education and training, champion identification, iterative adaptation, auditing, and ideally, feedback to clinicians.

What is the function of checklists in handoffs?

Checklists address only one function of handoffs—information exchange. Successful handoff standardization interventions not only include checklists or templates, but they also create expectations of clinician involvement, and they specify the ideal conditions for handoffs to occur.

Can standardized processes improve patient outcomes?

Clearly, there can be no true improvement in patient outcomes, even with the best standardized process, if the process is not adopted and durably followed by the clinicians responsible for patient care. For this reason, future studies require attention to implementation strategy.

Is perioperative handoff heterogeneous?

Perioperative handoffs are heterogeneous in settings, participants, and objectives. One way to categorize perioperative handoffs is by where and when they occur, e.g., preoperatively from floor-to-operating room (OR) or intensive care unit (ICU)-to-OR, and postoperatively from OR-to-ICU (see article by Dr. Lorinc in this issue). Another approach, proposed by Lane-Fall and colleagues, is a three-part taxonomy of handoffs based upon the type of transfer of care:

Introduction

As inpatient care becomes increasingly complex, with complicated medical problems and large volumes of information to transmit, appropriate and efficient communication among physicians is more critical than ever. According to The Joint Commission, communication breakdowns are estimated to contribute to 80% of medical errors.

Role of Standardization

Depending on physicians’ needs and responsibilities, handoff content will vary, requiring customization by individual physician groups; there is no “one size fits all” content. Once a group agrees on its customized content and processes, communication improves when the handoffs are standardized within a group.

Role of Technology

Technology provides a means to standardize the content for handoffs 15 and to decrease illegible writing. 10 Web-based applications have been used to decrease variability.

Review Patient Information

Handoffs provide a mechanism to review laboratory and radiographic studies and to discuss difficult diagnoses and challenging patients. Because handoffs are conducted among colleagues, they are a routine, expected, nonthreatening, and natural way to review diagnostic and treatment plans between each shift.

Financial Support

Because most handoffs do not involve direct face-to-face patient contact and are not documented in the medical record, direct billing for these services is problematic. Other factors, including physician payment structure, will encourage or discourage appropriate handoffs.

Training and Monitoring Handoff Communication

Residency training programs have understood the importance of handoff communication for decades. However, the Accreditation Council on Graduate Medical Education heightened its attention to handoffs as duty hours were implemented and later revised.

Summary

Handoffs improve when communication is standardized by and within individual physician groups. Individual groups may customize their sign-out process and content to meet their needs, patient needs, organizational culture, and available technology support.

Handoffs

See more on apsf.org

Preoperative

Intraoperative

Postoperative

Summary

References