Improving quality of care in less than 1 min: a prospective intervention study on postoperative handovers to the ICU/PACU.

Abstract

Standardisation of the postoperative handover process via checklists, trainings or procedural changes has shown to be effective in reducing information loss. The clinical friction of implementing these measures has received little attention. We developed and evaluated a visual aid (VA) and >1 min in situ training intervention to improve the quality of postoperative handovers to the intensive care unit (ICU) and postoperative care unit. The VA was constructed and implemented via a brief (<1 min) training of anaesthesiologic staff during the operation. Ease of implementation was measured by amount of information transferred, handover duration and handover structure. 50 handovers were audio recorded before intervention and 50 after intervention. External validity was evaluated by blinded assessment of the recordings by experienced anaesthesiologists (n=10) on 10-point scales. The brief intervention resulted in increased information transfer (9.0-14.8 items, <i>t</i>(98)=7.44, p<0.0001, Cohen's d=1.59) and increased handover duration (81.3-192.8 s, <i>t</i>(98)=6.642, p=0.013, Cohen's d=1.33) with no loss in structure (1.60-1.56, <i>t</i>(98)=0.173, p=0.43). Blinded assessment on 10-point scales by experienced anaesthesiologists showed improved overall handover quality from 7.1 to 7.8 (<i>t</i>(98)=1.89, p=0.031, Cohen's d=0.21) and improved completeness of information (<i>t</i>(98)=2.42, p=0.009, Cohen's d=0.28) from 7.3 to 8.3. An intervention consisting of a simple VA and <1 min instructions significantly increased overall quality and amount of information transferred during ICU/postanaesthetic care unit handovers.