Handoffs of Surgical Patients - Types, Standardization, and Factors Affecting

Introduction:

Transferring patients increases the risk factor for adverse events and can delay diagnosis and treatment. In addition, hospital work patterns can change, so the management of patients could be affected because of unfamiliarity or communication failure. Moreover, it is difficult for the same team to look after the patient, so handing over their care and responsibility to the next team ensures uncompromised care and provides the health professionals with the opportunity to unwind. Therefore, communication between health professionals is important, which can result in effective handoffs through improved quality in the care of the patient. However, strategy varies with different patients.

What Is Handoffs of Surgical Patients?

It can be defined as the process where the patient is transferred to another surgeon. Transferring of patients' care and duties occurs multiple times, such as during anesthesia providers in the operating room, post-anesthesia care unit, or intensive care unit, including surgical staff, anesthesia staff, a clinician, and a ward nurse. If the information is misunderstood, it can lead to serious consequences.

What Is the Standardization of Handoffs of Surgical Patients?

The transfer of standardized information during the pre-operative and perioperative period should include patient history, intraoperative events, and post-operative care plan through written and verbal communication; and a physical checklist for monitoring vital information. These are important in maintaining standardized handoffs. Therefore, healthcare providers should maintain communication checklists and protocols. Moreover, handover training should be provided to healthcare providers.

Common mnemonics (a memory aid that involves rhyme or abbreviation) can be used, such as:

• SBAR stands for

  • Situation refers to patients' problems, symptoms, and stability.

  • Background refers to the patient's history, including allergies and medications, symptoms, diagnosis, and reasons for being admitted to the hospital.

  • Assessment includes vital signs, clinical signs supporting the diagnosis, planned procedures and treatments with their results.

  • The recommendation includes ongoing care with plans and risks.

Therefore, SBAR significantly increased the QUALPACS (Quality patient care scale) score.

• I-PASS the BATON stands for

  • Introduction.

  • Patient summary.

  • Action list.

  • Situational planning.

  • Safety concerns.

  • Background.

  • Actions.

  • Timings.

  • Ownership.

  • Next plans.

• 5-Ps stands for

  • Precaution on isolation and allergies.

  • Patient's identity.

  • Plan of care.

  • Problem assessment.

  • Purpose.

• HANDOFF stands for

  • Hospital location.

  • Allergies/adverse reactions/medications.

  • Name and number.

  • DNAR/diet/DVTprophylaxis.

  • Ongoing medical and surgical problems.

  • Facts about hospitalization.

  • Follow-up.

• SIGN OUT stands for

  • Sick or DNR.

  • Identifying data.

  • General hospital course.

  • New events of the day.

  • Overall health status/clinical condition.

  • Upcoming possibilities with a plan.

  • Tasks to complete.

All these strategies apply between anesthesiologists, practitioners, physicians, internal medicine residents, operative staff, pharmacists, radiologists, SICU (surgical intensive care unit) nurses, and general nurses.

Why Is Effective Communication Important?

Effective and face-to-face communication is the most important part during handoffs to the surgical patient because:

• Transitions occur multiple times from the pre-operative unit to the perioperative unit to the post-operative unit and then to the monitoring ward.

• Care is handed over repeatedly to different health providers.

Effective communication depends on personnel dynamics, including the delivery and receiving providers' communication skills. Effective handoffs can improve patient care quality, leading to fewer preventable complications and reducing morbidity and mortality.

EHR (Electronic health records) templates are useful in improving physicians' notes because of the automated information process, discouraging ambiguous findings, highlighting important findings, improving patient rapport, and helping in continued care. EHR contains detailed information, but many providers usually neglect it; face-to-face verbal communication is important during handoffs.

What Are the Factors Affecting Quality Handoffs?

• Transferring information between healthcare providers.

• Shared understanding.

• Working environment (a stressful environment can cause health professionals to interact and cooperate less).

• Rapid turnover of patients (increased admission and discharge).

• Healthcare behavior and experience.

• Communication skills.

• Documentation (it should contain all events that took place at the bedside).

• Hospital standards (should include systems and policies for verbal and written documents, which should contain all the information).

What Are the Distractions During Handovers?

Surgical residents are often interrupted by distractions, causing a potential source of error. Distractions can occur while transferring information to patients due to a lack of standardization, non-relevant conversations, incomplete transfer of information, omission of important points, provider fatigue, time constraints, multi-tasking, the physical setting, social settings, language barriers, and interruptions during handovers. Experience and training of health providers can also affect the quality of handover. Therefore, all these can affect the quality of care for patients and the quality of handoffs from delivering and receiving providers.

What Are the Types of Handoffs?

• Pre-operative Handoff: Handoff from the holding room to the operating room or intensive care unit [IUC] to the operating room. The information is exchanged from the patient or family member to the holding nurse, anesthesia, and surgical team.

• Intraoperative Handoff: Handoff between the anesthetic team and surgeon. It is often a rushed conversation.

• Post-operative Handoff: Handoff from the operating room (OR) to the post-anesthesia care unit (PACU) or operating room to the intensive care unit. This is a high-risk handoff where the information is exchanged between surgical team members to the intensive care unit team/room nurse/physicians. This handoff phase is high risk because of the physical movement of the patients, who are deprived of strength and more vulnerable to errors. It involves many healthcare providers from different departments, such as anesthetists, clinicians, surgeons, nurses, etc. There is a specialty checklist for surgeons and anesthetists to complete handoffs. A method called HATRICC (Handoffs and transitions in critical care) is implemented, which has 4 phases:

1. Needs Assessment: It consists of impressions about the current process, which requires real-time monitoring of heart rate and BP (blood pressure) data.

2. Adaptation and Implementation: Doctors will adapt the handoff process from the needs assessment findings.

3. Evaluation.

4. Data analysis.

This process increases the effectiveness of handoff by 60 % by improving patient outcomes.

• Single And Multidisciplinary Handoff: In single disciplinary, only physicians and nurses are involved, whereas in multidisciplinary, different team members contribute to handoff.

Conclusion:

Handover of patients for the continuation of their care and treatment is a complex process, and any distractions can result in patient harm. Therefore, handoffs should be standardized. Due to these standardization processes, the healthcare team can avoid errors by delivering effective treatment and care.