STEPP IN: A Multicenter Quality Improvement Collaborative Standardizing Postoperative Handoffs

Pediatrics. 2021 Dec 1;148(6):e2020016402. doi: 10.1542/peds.2020-016402.


Objective: To reduce care failures by 30% through implementation of standardized communication processes for postoperative handoff in NICU patients undergoing surgery over 12 months and sustained over 6 months.

Methods: Nineteen Children's Hospitals Neonatal Consortium centers collaborated in a quality improvement initiative to reduce postoperative care failures in a surgical neonatal setting by decreasing respiratory care failures and all other communication failures. Evidence-based clinical practice recommendations and a collaborative framework supported local teams' implementation of standardized postoperative handoff communication. Process measures included compliance with center-defined handoff staff presence, use of center-defined handoff tool, and the proportion of handoffs with interruptions. Participant handoff satisfaction was the balancing measure. Baseline data were collected for 8 months, followed by a 12-month action phase and 7-month sustain phase.

Results: On average, 181 postoperative handoffs per month were monitored across sites, and 320 respondents per month assessed the handoff process. Communication failures specific to respiratory care decreased by 73.2% (8.2% to 4.6% and with a second special cause signal to 2.2%). All other communication care failures decreased by 49.4% (17% to 8.6%). Eighty-four percent of participants reported high satisfaction. Compliance with use of the handoff tool and required staff attendance increased whereas interruptions decreased over the project time line.

Conclusions: Team engagement within a quality improvement framework had a positive impact on the perioperative handoff process for high-risk surgical neonates. We improved care as demonstrated by a decrease in postoperative care failures while maintaining high provider satisfaction.

Publication types

  • Multicenter Study

MeSH terms

  • Communication*
  • Hospitals, Pediatric
  • Humans
  • Infant, Newborn
  • Intensive Care Units, Neonatal
  • Patient Care Team
  • Patient Handoff / standards*
  • Patient Handoff / statistics & numerical data
  • Postoperative Complications / prevention & control*
  • Postoperative Period
  • Quality Improvement*
  • Respiratory Insufficiency / prevention & control*
  • Time Factors