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Sender and Receiver Patient Relays: Getting a Firm Grip on Post-Operative Anesthesia Handoffs

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For surgical patients, the continuum of care requires multiple handoffs between health care providers of significant patient data. Brief, informal, and unstructured handoffs result in the omission of essential information. The purpose of this systematic review was to ascertain best-practice handoff components for the transfer of relevant and meaningful patient data following surgery and to create a standardized, structured postoperative handoff tool to transfer patient information and care to PACU nurses. The question answered by this research is: In adult patients presenting for surgery what handoff strategies provide the most effective patient information transfers, compared to individualistic practices, in facilitating relevant and meaningful patient information transfers, minimal omissions of important data, and high-quality team function?

A search of the literature was conducted for peer-reviewed articles in CINAHL since 2011 and Cochrane, PubMed, and Web of Science databases since 2015. Search terms included variations in the spelling of post-operative and post-anesthesia, and words and phrases of handoff, handover, transition of care, transition in care, and patient handoff combined with standard, structure, bundle, process, checklist, protocol, format, information transfer, report, or patient data. Additional filters were human subjects, English language, and adult patients. A total of 468 original articles resulted. Citations were downloaded and imported into a citation manager. 104 duplicates were removed. Articles were screened by one reviewer using title and abstract with selection based on relevance to PICO elements.

This review analyzed the post-operative handoff process from perspectives of quality improvement initiatives, handoff tool interventions, and focus group interviews. Interdisciplinary committees, leaders, staff, and patients evidenced front-line stakeholder investment through processes to tool and audit validations and participation in questionnaires and surveys, observations and interviews, and handoff practice. Failed standardization pointed to clinicians using only portions of handoffs. Having needed patient data may prevent delayed or inadequate care during transitions. Checklist standardization complements clinician workflow and the handoff standardization process refers to expectations of clinician involvement, ideal handoff conditions, the complexity of patients, and undivided attention.

Leadership and organizational cultural climate can undermine team functioning and effectiveness of communication. Healthy safety culture and climate support teamwork and effective communication among employees of different experience levels and across professions. Directions for future research appear to focus on the impact of quality and safety culture on the effectiveness of handoffs and team function. Current handoff practice supports using standardized, structured tools with patient data pertinent to care. Patient monitoring and stabilization are performed before reports by the OR nurse or anesthesia provider. Reports are complementary and time-efficient, allowing for questions. In collaboration with the perioperative team and patient, a clear plan of care is understood. With customization of design, the post-operative anesthesia handoff accommodates most perioperative settings. Post-operative handoffs continue to be critically examined as a crossroad of patient care susceptible to error, with handoff tools, the handoff process, and handoff stakeholders forging a culture of quality and safety.

Evidence-based references
1. Weinger MB, Slagle JM, Kuntz AH, et al. A multimodal intervention improves postanesthesia care unit handovers. Anesthesia and Analgesia. 2015;121(4):957-971. doi:10.1213/ANE.0000000000000670
2. Redley B, Bucknall TK, Evans S, Botti M. Inter-professional clinical handover in post-anaesthetic care units: tools to improve quality and safety. INT J QUAL HEALTH CARE. 2016;28(5):573-579. doi:10.1093/intqhc/mzw073
3. Robinson NL. Promoting patient safety with perioperative hand-off communication. J PERIANESTH NURS. 2016;31(3):245-253. doi:10.1016/j.jopan.2014.08.144



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