Implementation of an Intraoperative Standard Handoff Tool Among Anesthesia Providers in a Rural Hospital

Abstract

Problem: A system assessment at an operating room in a small community hospital disclosed that a standardized handoff process among anesthesia providers does not exist intraoperatively. Bronchospasms, bleeding from nasal trumpet insertions, and double-dosing of antibiotics are adverse events that have occurred during relief periods. This quality improvement(QI) project is anticipated to impact ten anesthesia providers and over 5,000 patients annually. Purpose: The purpose of this QI initiative is to implement a standardized handoff checklist for anesthesia providers. The evidence-based intervention was the use of the PATIENT mnemonic checklist tool. The tool was developed to standardize transfer of care periods among nurse anesthetists. Methods: The project lead mobilized a team of stakeholders to assist in the planning, facilitating, and implementation of the initiative. Stakeholder buy-in was achieved by disseminating peer-reviewed literature. A weekly audit of the handoff tool was completed by a change champion. A provider questionnaire was emailed weekly to assess how often anesthesia providers employed the handoff checklist. Anesthesia providers reported all pertinent patient information daily using an anesthesia handoff validation tool. Results: Providers report on the patient’s status, airway, allergies, antibiotics, intravenous access, and narcotics 90% or more of the time. Temperature, ventilation, and twitches are mentioned less than 90% of the time. Providers have reported using the checklist between six to ten times 25% of the time and between one to five times 45% of the time. The checklist has not been used 30% of the time. Conclusion: Findings suggest that in the intraoperative setting, anesthesia providers are utilizing the handoff checklist tool to give report to oncoming providers. Although some providers have reported zero use of the checklist, others use it one to ten times per week.