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October 14, 2018
10/14/2018 7:30:00 AM - 10/14/2018 9:30:00 AM
Room North, Hall D, Area E
Standardization of Post Anesthesia Care Unit Hand Off Communication Process and Structure
Kyle M. Damron, D.O., Kevin Li, M.D., Rajeev Krishnaney-Davison, M.D., Kathryn Teague, D.O., Miguel Cruz, M.D.
The Cleveland Clinic Foundation, Cleveland, Ohio, United States
Disclosures: K.M. Damron: None. K. Li: None. R. Krishnaney-Davison: None. K. Teague: None. M. Cruz: None.
The Cleveland Clinic performed greater than 208,000 surgical cases in 2016, and yet despite the enormous surgical volume, the hand off communication process and structure from anesthesia providers to PACU nurses had not been standardized in our main PACUs. The lack of standardization can potentially result in omission of relevant patient information during hand offs between health care providers, potentially leading to patient harm. Our aim was to reduce handoff omissions by 25% between anesthesia personnel and PACU nurses in our PACUs by December 1, 2017. Our hypothesis was that standardization of hand offs would reduce errors in care and avoid adverse events that may be due to miscommunication or omission of vital patient information, as well as ultimately reduce time the patient spent in the PACU. A secondary aim of our project was avoid an increase in PACU hand off times with a goal of less than 6.5 minutes per transition of care. Information was gathered from PACU nurses on the types of omissions that generally occurred during a typical patient hand off from anesthesia providers in order to create a survey. This survey highlighted the 10 most noted omissions. From this information a checklist was created containing the “ideal” hand off information and was laminated and placed at each nursing station in the PACUs. Throughout a shift the nurses would receive transitions in care from anesthesia providers and would count the total number and types of omissions that occurred during their shift based on our checklist. After initial implementation, it was noticed that our checklists often were misplaced or thrown out, which was attributed to lack of awareness of the project aim. Subsequently, our study was more properly conveyed to the PACU nurses, and our checklist was secured to each nursing station to avoid misplacement. Prior to our third data collection, further reinforcement and reminders of our current project and ultimate goal was provided. Thus omission data was gathered on three occasions. Those personnel contributing to this effort included GENA staff, residents, CRNA’s and PACU nurses. The pre-intervention survey showed 80% of the omissions occurred due to PACU orders not being placed and missing pertinent past medical history. Other notable omissions included medications, preoperative cognition, intraoperative fluid management, pain management plan, airway details, reason for procedure and current IV access. After the second survey there was a 17% reduction in total omissions and after the third survey an additional 15% decrease in total omissions (32% total reduction in pertinent omissions when compared to the initial survey). Our secondary aim of increasing efficiency and avoiding an increase in PACU hand off times (goal of less than 6.5 minutes per handoff) was met and exceeded our goal with an actual reduction in transition-of-care time. Despite our early success, it is important to continue to modify and revamp the standardized hand off process. We will continue to provide monthly reminders to anesthesia providers and PACU nurses and collect data to promote continual use of the hand off checklist. Future ideas to further implement standardization include streamlining the hand off approach by including patient information on our anesthesia record keeping system (ARKS) handout, providing an alert in ARKS that will prohibit the anesthesia staff from moving forward in the hand off process without all areas accounted for. These measures will allow us to view variance and improve our training overall, and most importantly, continue to reduce omissions in the hand off process in order to prevent patient harm.

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