Improving Transitions of Care in the Perioperative Setting

It is estimated that nearly 200,000 Americans die each year due to preventable medical mistakes (Gupta, 2012), and nearly 80% of all medical errors involve some form of miscommunication between healthcare providers (Joint Commission Center for the Transformation of Healthcare, 2013). Handoffs, or the transitioning of patient care from one provider to another, occur multiple times each day in the hospital setting and done incorrectly can lead to significant mistakes in patient care. The purpose of this project was to improve the quality of handoffs that occurred between perioperative and inpatient nurses at an urban, tertiary medical center. A shared governance model was used to establish a team of key end-users from each of the involved units. These participants reviewed available models for handoff communication and chose a tool as their preferred method. The tool then was customized to include key information that was deemed important by the end users and a final version of the handoff tool was developed. This standardized method was then utilized for most patient handoffs that occurred from the Main Pre/Post Unit (PACU) and Interventional Radiology to two participating inpatient units. Nurses on each unit were given an eight-question survey to assess their perception of the quality of the handoffs that were occurring prior to the start of the project and the same survey was administered again at the conclusion of the project. Additionally, to assess compliance with the handoff tool, nurses from both the sending unit and receiving unit were asked to complete a five-question evaluation after each individual patient handoff. During the pre-implementation period, 86 nurses completed the survey to determine their perception of the quality of the handoffs and their mean score was 4.53 (range 0-8). Forty-six nurses completed the survey post-intervention, with a mean score of 5.78 (range 0-8). Survey results demonstrated a statistically significant difference in the mean scores between the surveys at a p < .000 level. This indicates that the standardized handoff tool was effective at improving the perception of quality by nurses. Individual handoff surveys showed that with the implementation of a standardized handoff tool, 97.4% of nurses that were giving report to another nurse felt that their handoff was accurate and appropriately reflected the patient's condition. In addition, the sending nurses were satisfied with the handoff that they provided 100% of the time. The nurses receiving the report answered that the handoff was an accurate representation of the patient's clinical condition 93.8% of the time and that they were satisfied with the overall handoff they received 89.6% of the time. In summary, the results demonstrated that the standardization of a handoff tool, when patients were moved from a Perioperative to inpatient unit, was able to improve the perceived quality of the handoff.