Elsevier

Journal of Critical Care

Volume 32, April 2016, Pages 170-174
Journal of Critical Care

Clinical Potpourri
The effect of a checklist on the quality of patient handover from the operating room to the intensive care unit: A randomized controlled trial

https://doi.org/10.1016/j.jcrc.2015.12.016Get rights and content

Abstract

Purpose

Handover of patient care is a potential safety risk for the patient due to loss of information which may result in adverse outcome. We hypothesized that a checklist for handover from the operating room (OR) to the intensive care unit (ICU) will lead to an increase of quality regarding information transfer compared with a nonstandardized handover procedure.

Materials and methods

The study was conducted as a prospective, randomized trial in a university hospital. The quality of handovers with checklist was compared with handovers without checklist. Handovers were recorded by digital voice recorder and analyzed using an individual rating sheet for each patient. This enabled to discriminate between items that “must be handed over” (red items) and items that “should be handed over” (yellow items).

Results

A total of 121 patient handovers from OR to ICU were included. Significantly more red items were handed over in the study group compared with the control group (study group: median 87.1%, 25-27 percentile 77.1%-90.0%; control group: median 75.0%, 25-75 percentile 66.7%-88.6%; P < .01).

Conclusions

This study gives first evidence that the use of a standardized checklist for patient handover from OR to ICU increases the quantity and quality of transmitted medical information.

Introduction

Handover of patient care and responsibility is a potential safety risk for the patient due to loss of information with influence on patient outcome [1]. However, transfer of patient responsibility is unavoidable because care for the individual often outlasts one working shift or a patient is transferred between different departments in the hospital. During their treatment, patients undergoing major surgery are frequently exposed to multiple handovers. One of them is the handover from the operating room (OR) to the postanesthesia care unit or the intensive care unit (ICU). These patients often undergo major surgical procedures frequently associated with acute pathophysiologic deteriorations and furthermore exhibit extensive comorbidities. Their transfer is a highly complex work process. In consequence, many of those patients require complex treatment during the phase of handover, such as mechanical ventilation and/or hemodynamic support by continuous infusion of catecholamines, which requires constant attention from the care giving team. In the handover process, responsibility for these critically ill patients is completely transferred from one team to another one. Earlier studies have shown that postoperative handovers are often informal, brief [2], [3], [4], and frequently incomplete [5], [6]. A medical error caused by insufficient transfer of information may lead to patient harm [7]. An analysis of adverse clinical incidents occurring in the recovery area showed that 14% of incidents happened because of communication failure [8].

To avoid loss of information during patient transfer, standardized protocols can help to increase the completeness of postanesthesia handover [6], [7], [9], [10], [11]. These types of protocols, such as a checklist, have been demanded for years by different medical associations and the World Health Organization [12], [13]. Although many studies have dealt with health care handover, only few have focused on handover in the perioperative setting [14] and critically ill patients. Furthermore, it is not clear if handover checklists only increase quantity, for example, the number of single items handed over regardless of their relevance for the individual patient in this particular situation, or if they also increase their quality, for example, a gain of patient- and context-specific information handed over.

Therefore, the aim of the present study was to investigate the effect of the use of a checklist for postanesthesia handover in the ICU. Our primary end point was that a checklist will lead to an increase of quantity (less items will be omitted). Secondary end point was also quality (the individually important items will be handed over) of information transfer compared with non-standardized handovers.

Section snippets

Methods

After approval of the ethics committee of the Medical Board of the City of Hamburg (PV4074) and the institutional workers’ council of the Hamburg-Eppendorf University Medical Centre and with written informed consent of the participating anesthesiologists and critical care physicians, 121 handovers of patients transferred from the OR to the ICU were included into this study. Because no specific personal or medical records directly related to patients were assessed, written informed consent from

Statistical analysis

Sample size calculation for the primary study end point was based on an aimed difference in the information items handed over of 20% between the control and the intervention group. With a power of 80% and a statistical significance of P < .05, a total of 116 patients had to be included, 58 per group. Data were analyzed using Microsoft Excel 2010 (Microsoft, Redmond, WA) and SigmaPlot 12.0 (Systat Software, Hamburg, Germany). The percentage of demanded items handed over was calculated for every

Results

The handovers of 134 patients were included in this study. Two handovers were missed because of overlapping handovers. One hundred thirty-two handovers were recorded. From those, 11 handovers had to be excluded from analysis because of missing assessment sheets or technical problems with the recording of the handover. Finally, 121 handovers were included in the analysis (Fig. 1), with 60 handovers in the intervention group and 61 in the control group.

After first assessment, both investigators

Discussion

The results of this study give first evidence that the use of a checklist for medical handovers of patients from the OR to the ICU not only increases the quantity of information transported but also increases the quality, for example, the amount of patient- and context-specific information transmitted.

Several studies have shown that the use of a checklist for postoperative handovers of patients increases the quantity of items handed over [6], [7], [9], [10], [11], most of them focusing on

Conclusion

Patient handover is a complex intervention, and the use of a standardized checklist for handover from OR to ICU increases the quantity and quality of transmitted medical information. It should be implemented in all perioperative settings to improve patient safety.

The following are the supplementary data related to this article.

. Checklist for patient handover

. Handover items + assessment

Funding

This investigator-initiated and investigator-driven study was funded by departmental resources only.

Conflict of interests

None.

Acknowledgments

We acknowledge all anesthesiologists and critical care physicians of the University Hospital Hamburg-Eppendorf that participated in this study.

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