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Intraoperative patient information handover between anesthesia providers.

Choromanski D, Frederick J, McKelvey GM, Wang H - J Biomed Res (2014)

Bottom Line: Studies on anesthetic handover in the US recovery room setting observed that handover processes are insufficient and, in many instances, significant intraoperative events are disregarded.Out of all respondents (n = 212), 49.1 % had no hand-over protocol at their institution and 88% of respondents who did have institutional handover protocols believed them insufficient for effective patient handover.In conclusion, handover transition of patient care is a vulnerable and potentially life-threatening event in the operating room.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology, Childrens Hospital of Michigan, Wayne State University, Detroit, MI 48201, USA.

ABSTRACT
Currently, no reported studies have evaluated intraoperative handover among anesthesia providers. Studies on anesthetic handover in the US recovery room setting observed that handover processes are insufficient and, in many instances, significant intraoperative events are disregarded. An online survey tool was sent to anesthesia providers at US anesthesia residency programs nationwide (120 out of the 132 US programs encompassing around 4500 residents and their academic MDAs) and a smaller survey selection of CRNAs (10 institutions about 300 CRNAs in the metropolitan area of Detroit, MI, USA) to collect information on handover practices. The response rate to this survey (n = 216) was comprised of approximately 5% (n = 71) of the resident population in US anesthesia programs, 5% (n = 87) of MDAs , and 20% (n = 58) of the CRNAs. Out of all respondents (n = 212), 49.1 % had no hand-over protocol at their institution and 88% of respondents who did have institutional handover protocols believed them insufficient for effective patient handover. In addiiton, 84.8% of all responders reported situations where there was insufficient information received during a patient handover. Only 7% of the respondents reported never experiencing complications or mismanagement due to poor or incomplete hand-overs. In contrast, 60% reported rarely having complications, 31% reported sometimes having complications, and 3% reported frequent complications. In conclusion, handover transition of patient care is a vulnerable and potentially life-threatening event in the operating room. Our preliminary study suggests that current intraoperatvive handover practices among anesthesia providers are suboptimal and that national patient handover guidelines are required to improve patient safety.

No MeSH data available.


Related in: MedlinePlus

Survey question 4.On a scale from 1–5, how frequently do you cover the following patient information during the hand-over? Key - (1  =  Never, 2  =  Rarely, 3  =  Sometimes, 4  =  Frequently, 5  =  Always. Patient information factors expressed as a % proportion of total survey response.
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f01: Survey question 4.On a scale from 1–5, how frequently do you cover the following patient information during the hand-over? Key - (1  =  Never, 2  =  Rarely, 3  =  Sometimes, 4  =  Frequently, 5  =  Always. Patient information factors expressed as a % proportion of total survey response.

Mentions: From all questionnaires received (n = 216), 87 (40.3%) of respondents were MDAs, 71 (32.9%) were MDAR, and 58 were CRNAs (26.9%; Table 1). The response rate to this survey was low with a response from approximately 5% of the resident population in US anesthesia programs and approximately 20% of the CRNAs surveyed in the metropolitan Detroit area. Of all respondents, 108 (49.1 %) stated that they did not have a handover protocol at the institution where they practiced (Table 1). Of the respondents who did have an institutional handover policy, 11.2% stated that that protocol included the necessary elements for effective handover. Furrthermmore, 85.7% respondents reported not having a departmental standardized handover form (Table 2). Of all responders, 84.8% (173/204) had an experience where they had not received sufficient information during a patient handover. Only 7.4% (15/203) of respondents had never experienced complications or mismanagement due to poor or incomplete handover. In comparison, 59.6% (121/203) reported rarely having complications, 30.5% (62/203) reported sometimes having complications and 2.5% (5/203) reported frequently having complications (Table 3). Based on the informal prelimanary survey, the specific handover information has been developed. Respondents were asked to respond on the frequency in which they addressed the specific handover information such as allergies and medications, past medical history, intraoperative events (anesthesia related and surgery related), postoperative plans (extubation/ICU, etc.), special concerns (code status, Jehovah's witness, type and screen antibodies, airway information (ie. h/o difficult intubation) and significant diagnostic studies (e.g Blood lab, EKG, Chest X-ray, Stress tests, Pulmonary Function Tests, etc.). For this specific handover information, the majority of providers frequently or always relayed information regarding patient allergies (89.2%), past medical history (99%), anesthesia related intraoperative events (99%), surgery related intraoperative events (91.7%), airway information (97.5%) and significant diagnostic studies (84.2%; Fig. 1). However, information about medications (31.4%), postoperative plan (19.1%), code status (75.4%), information about refusal of blood (21.1%) and type and screen antibodies (49%) were either sometimes, rarely or never included during handover. From the specific list of patient handover information factors, 80.5% (165/204) of responders stated that these factors would be sufficient for an effective, complete handover.


Intraoperative patient information handover between anesthesia providers.

Choromanski D, Frederick J, McKelvey GM, Wang H - J Biomed Res (2014)

Survey question 4.On a scale from 1–5, how frequently do you cover the following patient information during the hand-over? Key - (1  =  Never, 2  =  Rarely, 3  =  Sometimes, 4  =  Frequently, 5  =  Always. Patient information factors expressed as a % proportion of total survey response.
© Copyright Policy
Related In: Results  -  Collection

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getmorefigures.php?uid=PMC4197389&req=5

f01: Survey question 4.On a scale from 1–5, how frequently do you cover the following patient information during the hand-over? Key - (1  =  Never, 2  =  Rarely, 3  =  Sometimes, 4  =  Frequently, 5  =  Always. Patient information factors expressed as a % proportion of total survey response.
Mentions: From all questionnaires received (n = 216), 87 (40.3%) of respondents were MDAs, 71 (32.9%) were MDAR, and 58 were CRNAs (26.9%; Table 1). The response rate to this survey was low with a response from approximately 5% of the resident population in US anesthesia programs and approximately 20% of the CRNAs surveyed in the metropolitan Detroit area. Of all respondents, 108 (49.1 %) stated that they did not have a handover protocol at the institution where they practiced (Table 1). Of the respondents who did have an institutional handover policy, 11.2% stated that that protocol included the necessary elements for effective handover. Furrthermmore, 85.7% respondents reported not having a departmental standardized handover form (Table 2). Of all responders, 84.8% (173/204) had an experience where they had not received sufficient information during a patient handover. Only 7.4% (15/203) of respondents had never experienced complications or mismanagement due to poor or incomplete handover. In comparison, 59.6% (121/203) reported rarely having complications, 30.5% (62/203) reported sometimes having complications and 2.5% (5/203) reported frequently having complications (Table 3). Based on the informal prelimanary survey, the specific handover information has been developed. Respondents were asked to respond on the frequency in which they addressed the specific handover information such as allergies and medications, past medical history, intraoperative events (anesthesia related and surgery related), postoperative plans (extubation/ICU, etc.), special concerns (code status, Jehovah's witness, type and screen antibodies, airway information (ie. h/o difficult intubation) and significant diagnostic studies (e.g Blood lab, EKG, Chest X-ray, Stress tests, Pulmonary Function Tests, etc.). For this specific handover information, the majority of providers frequently or always relayed information regarding patient allergies (89.2%), past medical history (99%), anesthesia related intraoperative events (99%), surgery related intraoperative events (91.7%), airway information (97.5%) and significant diagnostic studies (84.2%; Fig. 1). However, information about medications (31.4%), postoperative plan (19.1%), code status (75.4%), information about refusal of blood (21.1%) and type and screen antibodies (49%) were either sometimes, rarely or never included during handover. From the specific list of patient handover information factors, 80.5% (165/204) of responders stated that these factors would be sufficient for an effective, complete handover.

Bottom Line: Studies on anesthetic handover in the US recovery room setting observed that handover processes are insufficient and, in many instances, significant intraoperative events are disregarded.Out of all respondents (n = 212), 49.1 % had no hand-over protocol at their institution and 88% of respondents who did have institutional handover protocols believed them insufficient for effective patient handover.In conclusion, handover transition of patient care is a vulnerable and potentially life-threatening event in the operating room.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology, Childrens Hospital of Michigan, Wayne State University, Detroit, MI 48201, USA.

ABSTRACT
Currently, no reported studies have evaluated intraoperative handover among anesthesia providers. Studies on anesthetic handover in the US recovery room setting observed that handover processes are insufficient and, in many instances, significant intraoperative events are disregarded. An online survey tool was sent to anesthesia providers at US anesthesia residency programs nationwide (120 out of the 132 US programs encompassing around 4500 residents and their academic MDAs) and a smaller survey selection of CRNAs (10 institutions about 300 CRNAs in the metropolitan area of Detroit, MI, USA) to collect information on handover practices. The response rate to this survey (n = 216) was comprised of approximately 5% (n = 71) of the resident population in US anesthesia programs, 5% (n = 87) of MDAs , and 20% (n = 58) of the CRNAs. Out of all respondents (n = 212), 49.1 % had no hand-over protocol at their institution and 88% of respondents who did have institutional handover protocols believed them insufficient for effective patient handover. In addiiton, 84.8% of all responders reported situations where there was insufficient information received during a patient handover. Only 7% of the respondents reported never experiencing complications or mismanagement due to poor or incomplete hand-overs. In contrast, 60% reported rarely having complications, 31% reported sometimes having complications, and 3% reported frequent complications. In conclusion, handover transition of patient care is a vulnerable and potentially life-threatening event in the operating room. Our preliminary study suggests that current intraoperatvive handover practices among anesthesia providers are suboptimal and that national patient handover guidelines are required to improve patient safety.

No MeSH data available.


Related in: MedlinePlus