Standardized protocol improves the transfer of cardiac surgery patients to intensive care
Patient Safety and Quality
Handing off a patient after surgery to another unit of the hospital involves exchanges of information and technology between multiple care providers. This is particularly true for adult cardiac surgery patients being transferred to the cardiac surgical intensive care unit (CSICU). Recently, a large teaching hospital developed and implemented a new OR-to-ICU protocol designed to improve the transfer of these high-risk patients. The protocol reduced missed information during patient transfer and improved handoff satisfaction scores among CSICU nurses.
A variety of professionals provided input for the new protocol, including anesthesia and surgical providers, intensivists, and nurses. The protocol specified which team members should be present at the patient’s bedside before, during, and after the handoff. Detailed instructions were also given on information and technology transfers, how to complete a handoff report, and the use of checklists. Laminated handoff protocol schematics and checklist tool pocket cards were also developed and distributed. A total of 238 health care providers participated in the handoff of 30 patients prior to the intervention protocol and 30 patients after the protocol was implemented.
Use of the new protocol only increased handoff duration from 11 minutes to 12 minutes. The presence of designated team members at the bedside rose from 0 percent at baseline to 68 percent after the protocol was put into place. Missed information in the surgery report decreased from 26 percent to 16 percent. Handoff satisfaction scores among CSICU nurses increased from 61 percent to 81 percent. Overall, the new protocol improved information sharing and the multidisciplinary strength of the patient handoff without increasing transfer time.
The study was supported in part by AHRQ (HS13904). See "Pilot implementation of a perioperative protocol to guide operating room-to-intensive care unit patient handoffs," by Michelle A. Petrovic, M.D., Hanan Aboumatar, M.P.H., M.D., William A. Baumgartner, M.D., and others in the Journal of Cardiothoracic and Vascular Anesthesia 26(1), pp. 11-16, 2012.