Improve Continuity of Care Using Perioperative Handoff Communication Tool

Abstract

Problem: Effective handoff communication (HOC) between the Operating Room (OR) staff and the Post-anesthesia Care Unit (PACU) staff is essential to patient safety. Over 80% of sentinel events are related to poor HOC leading to nearly 2,000 lives lost and $1.7 billion in medical costs. HOC in a large academic center PACU is not standardized and often interrupted resulting in omissions. A survey of PACU staff showed <50% satisfaction with the HOC process and inconsistent HOC information raising concerns for patient safety and continuity of care. Purpose: The purpose of this quality improvement project was to implement the evidence-based HOC tool, Introduction, Situation, Background, Assessment, and Recommendation (ISBAR) with PACU Pause, to improve continuity of care through standardized patient information transfer and improve health care provider postoperative communication satisfaction. Methods: A multidisciplinary team was formed to develop an educational competency and implement the HOC tool ISBAR with PACU Pause. Pre and post implementation HOC audits were completed using an evidenced-based 20-item critical element HOC. Post implementation PACU staff completed anonymous surveys to assess staff satisfaction. Results: Implementation of the HOC tool, ISBAR with PACU Pause, resulted in an improved percent change of key patient information inclusion from 65.48% to 83.03%. Thirteen of the twenty critical HOC elements increased >10%. Staff satisfaction with the ISBAR with PACU Pause increased from <50% to >85%. Conclusion: Findings suggest the ISBAR provides clear steps for HOC while the PACU Pause empowers staff to request time to prepare for the patient handoff. This HOC results in more accurate and complete handoff of patient information and increased provider satisfaction with the handoff process.