A Multimodal Intervention Improves Postanesthesia Care Unit Handovers

Anesth Analg. 2015 Oct;121(4):957-71. doi: 10.1213/ANE.0000000000000670.

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.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Aged
  • Anesthesia / standards*
  • Anesthesia / trends
  • Cohort Studies
  • Combined Modality Therapy / standards
  • Combined Modality Therapy / trends
  • Continuity of Patient Care / standards
  • Continuity of Patient Care / trends
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Patient Handoff / standards*
  • Patient Handoff / trends
  • Postoperative Care / standards*
  • Postoperative Care / trends