OR Manager - January 2020 - 22

Reinvent and reap the rewards of improved handoffs-Part 1
Periop nursing
care transition poses a danger
point for patients-failing to
" hand off " needed information
from one clinician to another can lead to
significant morbidity and mortality. The
Joint Commission was so concerned
about handoffs that in 2017 it issued a
A
sentinel event alert on the topic.
" Handoffs are a safety opportunity
because they promote a fresh look,
which can help catch safety hazards, "
says Meghan Lane-Fall, MD, MSHP,
FCCM, assistant director, Penn Center
for Healthcare Improvement and Patient
Safety; codirector, Penn Center
for Perioperative Outcomes Research
and Transformation at the University of
Pennsylvania in Philadelphia; and assistant
professor of anesthesiology and
critical care at the Perelman School of
Medicine, University of Pennsylvania.
Amanda
Lorinc, MD
Tools such as checklists
can provide a framework
for the handoff, but the
key component is communication.
" Handoffs
are about communication,
not about checking
a box on a checklist, "
says Amanda Lorinc,
MD, assistant professor in the division
of pediatric anesthesiology at Monroe
Carell Jr Children's Hospital at Vanderbilt
University Medical Center in Nashville,
Tennessee. " You need to tailor the
process to your hospital and to the various
locations within the hospital so that
it's most effective. "
In this two-part series, we first explore
the nature of handoffs and how
they benefit patients and OR leaders
(Part 1). We then outline best practices
for ensuring handoffs are both efficient
and effective (Part 2).
The case for handoffs
Research related to handoffs has focused
on how to improve the process,
and many studies have taken place in
a single facility. Despite study limitations,
good handoffs have been shown
to reduce technical errors and omission
22
OR Manager | January 2020
Perioperative handoffs occur in a variety of locations.
Source: Amanda Lorinc, MD. Used with permission.
of critical information, Dr Lane-Fall says.
She and Dr Lorinc both emphasize,
however, that more outcomes-based
research is needed.
But in terms of outcomes, it's difficult
to study handoffs the same way
as other clinical interventions. " There
isn't a one-to-one relationship between
handoffs and patient outcomes, " Dr
Lane-Fall says. " You can have a perfect
handoff in a really sick patient who still
dies, and you can have a terrible handoff
with a patient who is healthy, and he
doesn't die. "
The number of factors affecting communication,
such as level of staffing,
patient volume, and competing priorities,
that aren't related to the handoff
are too numerous to be able to draw
conclusions about how handoffs are
linked to mortality and morbidity outcomes.
Dr Lane-Fall says that doesn't
mean handoffs aren't important, but it
does mean outcomes metrics have to
be carefully chosen.
Metrics such as time saved might be
better and have the added advantage
of making the business case for handoffs.
" There are efficiencies to be gained
from doing handoffs well, " she says. For
example, a good handoff avoids multiple
calls from the clinician receiving the patient
to the previous caregiver to obtain
missing information. The minutes saved
add up and are particularly important
for busy ORs seeking to minimize turnover
time and maximize other production
metrics such as first case on-time
starts. (See related story, p 24.) A good
handoff also avoids redundancies in test
ordering, thus reducing costs.
Dr Lorinc says handoffs don't have
to add time to the workday and can
even save time in relaying critical information.
She was the lead investigator
for a study that found implementing a
clinician-centered preoperative handover
process and checklist for patients
being transferred from the neonatal ICU
to the OR reduced information transfer
time from an average of 11.7 minutes
to 10.1 minutes, with the time needed
to complete the handover checklist averaging
4.7 minutes. In addition, the
effectiveness of the handoff increased
from 2.9 to 3.85 (with 5 being extremely
effective).
In addition to saving time, handoffs
can protect the organization from liability.
Hospitals that do not follow standards
from the Joint Commission or
professional associations like AORN are
vulnerable to potential
lawsuits stemming
from an error caused by poor communication
during a care transition.
The Joint Commission Provision of
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OR Manager - January 2020

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