Postoperative Handoff Tool Implementation: Post Anesthesia Care Unit

Abstract

Background: Providing concise postoperative handoff in a Post Anesthesia Care Unit requires that tools and processes are in place. Despite utilizing a handwritten paper containing patient information obtained from the Post Anesthesia Care Unit charge nurse and the operative nurse report prior to the patient transferring to the Post Anesthesia Care Unit from the operating room, many nurses reported feelings of being rushed through report or not having enough time to ask questions and write detailed notes. A formalized postoperative handoff tool was not being utilized in the Post Anesthesia Care Unit necessitating the need for the development and implementation of a unit specific postoperative handoff tool.

Local Problem: Patients receive care from multiple subspecialties and are managed by multiple services during their stay in the Post Anesthesia Care Unit, thus requiring multiple Health Care Provider handoffs. This places the patient at risk for potential errors in care secondary to communication errors. The goal of this quality improvement project was to develop, implement, and evaluate a postoperative handoff tool, thereby increasing Health Care Provider satisfaction with the postoperative handoff tool and procedure in a Post Anesthesia Care Unit, at a large academic medical center in the mid-Atlantic.

Interventions: The purpose of this Doctor of Nursing Practice project was to implement a quality improvement project using an evidence-based postoperative handoff tool to improve Health Care Provider postoperative communication to facilitate the transfer of standardized and comprehensive information. Prior to and fourteen weeks following implementation, Health Care Providers completed surveys to assess the satisfaction of the postoperative handoff tool and process. Compliance and completion rates of tool utilization were then assessed for improvement. Results: There was improvement in Health Care Provider satisfaction with the handoff tool postintervention (53.5% pre-intervention versus 80.95% post-intervention, p = 0.02). There was no significant difference in Health Care Provider satisfaction with the handoff process (60% preintervention versus 76.19% post-intervention, p = 0.14) or satisfaction with the usefulness of the handoff tool (46.47% pre-intervention versus 76.19% post-intervention, p = 0.08). There was no significant difference in the Health Care Providers need to contact surgical teams to clarify goals of care after handoff (33.34% pre-intervention versus 23.8% post-intervention, p = 0.05). There was no significant difference in the Health Care Providers understanding of goals of care after handoff (60% pre-intervention versus 90.48% post-intervention, p = 0.23) or understanding of the procedure after handoff (66.67% pre-intervention versus 80.95% post-intervention, p = 0.71). There was significant improvement by Health Care Providers in feeling that all question were answered during the handoff process (46.46% pre-intervention versus 80.96% post-intervention, p = 0.03). There was improvement in the postoperative handoff tool completion rates (85% at week 8 versus 94% at week 14). There was a 100% compliance rate with postoperative handoff tool utilization throughout implementation.

Conclusions: As a result of implementing a formalized postoperative handoff tool, Health Care Providers reported improved satisfaction with the handoff process and an improved perception of patient care secondary to a relay of information that was standardized and comprehensive. Postintervention, compliance and completion rates of the postoperative handoff tool improved.