UCLA

Purpose: To develop and implement a Structured Handoff from the operating room (OR) to pediatric cardiovascular intensive care unit (CVICU) to improve interdisciplinary team participation, completeness and timeliness of handoff information, and team satisfaction at a Southern California Children’s Hospital. Background: Ineffective handoffs have been identified as the 3rd most common cause of medical error and posing a significant threat to patient safety. Hand-offs from the OR to the pediatric CVICU represent one of the most demanding care transfers and, if inadequate, may result in loss or unreliable information and adverse events. Despite the Joint Commission recognition as an important patient safety goal, some centers have not incorporated handoff standards among their interdisciplinary teams. Methods: An Evidence Based Practice (EBP) methodology guided development of the handoff tool using current literature and unit-specific workflows. The tool was refined through staff and provider feedback and implemented over 14 weeks. Data collection occurred across three phases: pre-intervention, intervention, and post-intervention. Each phase included a minimum of 4 direct handoff observations assessing the outcome measures of timeliness of report, team member presence, and completeness of information. Staff satisfaction surveys were administered both pre- and post-intervention to evaluate satisfaction with the handoff report. Outcomes: Out of 33 surgical cases during 14-week implementation, 30 Handoff Forms were completed reporting a 91% utilization. Use of the form improved team participation (pre-85.7 vs. post-92.7%; 7.2% ↑), documentation accuracy (pre-83.5% vs. post-87.4%; 3.9% ↑) and staff satisfaction (pre-67% to post-80%; 13% ↑) with current handoff procedure. However, timeliness of report was longer (pre-12.3 minutes vs. post-25.5 minutes; 13.2 minutes↓). Ongoing challenges reported qualitatively in the post-survey were distractions in post-operative tasks and variability in adherence to handoff report process. Conclusions: This project demonstrated successful use of a EBP standardized handoff report form for patients transferred from the OR to the pediatric CVICU. Use of the form improved team participation, documentation accuracy, and staff satisfaction. While implementation resulted in longer report times, this was likely due to higher surgical complexity. Clinical Implications: This form can be adapted for other surgical units to drive system-wide, sustainable, interdisciplinary tracking.