A Multimodal Intervention Improves Postanesthesia Care Unit Handovers. (October 2015)

• Record Type: Journal Article
• Authors: Weinger, Matthew B.; Slagle, Jason M.; Kuntz, Audrey H.; Schildcrout, Jonathan S.; Banerjee, Arna; Mercaldo, Nathaniel D.; Bills, James L.; Wallston, Kenneth A.; Speroff, Theodore; Patterson, Emily S.; France, Daniel J.
• Is Part Of: Anesthesia & analgesia. Volume 121:Number 4(2015)
• Publication Date: 2015-10
• Subjects: Anesthesiology -- Periodicals; Anesthesia; Anesthesiology; Analgesia; Analgesics; Anesthesiology -- Periodicals; 617.9605
• DOI: 10.1213/ANE.0000000000000670
• Languages: English
• ISSNs: 0003-2999

Abstract

Abstract : BACKGROUND: Failures of communication are a major contributor to perioperative adverse events. Transitions of care may be particularly vulnerable. We sought to improve postoperative handovers. METHODS: We introduced a multimodal intervention in an adult and a pediatric postanesthesia care unit (PACU) to improve postoperative handovers between anesthesia providers (APs) and PACU registered nurses (RNs). The intervention included a standardized electronic handover report form, a didactic webinar, mandatory simulation training focused on improving interprofessional communication, and post-training performance feedback. Trained, blinded nurse observers scored PACU handovers during 17 months using a structured tool consisting of 8 subscales and a global score (1–5 scale). Multivariate logistic regression assessed the effect of the intervention on the proportion of observed handovers receiving a global effectiveness rating of ≥3. RESULTS: Four hundred fifty-two clinicians received the simulation-based training, and 981 handovers were observed and rated. In the adult PACU, the estimated percentages of acceptable handovers (global ratings ≥3) among AP-RN pairs, where neither received simulation-based training (untrained dyads), was 3% (95% confidence interval, 1%–11%) at day 0, 10% (5%–19%) at training initiation (day 40), and 57% (33%–78%) at 1-year post-training initiation (day 405). For AP-RN pairs where at least one received the simulation-based training (trained dyads), these percentages were estimated to be 18% (11%–28%) and 68% (57%–76%) on days 40 and 405, respectively. The percentage of acceptable handovers was significantly greater on day 405 than it was on day 40 for both untrained ( P < 0.001) and trained dyads ( P < 0.001). Similar patterns were observed in the pediatric PACU. Three years later, the unadjusted estimate of the probability of an acceptable handover was 87% (72%–95%) in the adult PACU and 56% (40%–72%) in the pediatric PACU. CONCLUSIONS: A multimodal intervention substantially improved interprofessional PACU handovers, including those by clinicians who had not undergone formal simulation training. An effect appeared to be present >3 years later. Abstract : Supplemental Digital Content is available in the text.Published ahead of print March 24, 2015