Literature Review

Criteria

Article 1

Article 2

Article 3

Article 4

Author, Journal (Peer-Reviewed), and

Permalink or Working Link to Access Article

Methangkool, E., Tollinche, L., Sparling, J., & Agarwala, A. V,  International Anesthesiology Clinics and https://doi.org/10.1097/aia.0000000000000241

Leonardsen, A., Moen, E. K., Karlsøen, G., & Hovland, T, Nursing Reports, and  https://doi.org/10.4081/nursrep.2019.8041

Lambert, L. H., & Adams, J.A, AANA journal and https://www.aana.com/docs/default-source/aana-journal-web-documents-1/improved-anesthesia-handoff-after-implementation-of-the-written-handoff-anesthesia-tool-(what)-aana-journal-october-2018.pdf?sfvrsn=770754b1_6

Potestio, C., Mottla, J., Kelley, E., & DeGroot, K, APSF Newsletter, and

https://lhatrustfunds.com/wp-content/uploads/2015/07/PACU-handoff.pdf

Article Title and Year Published

Communication: Is There a Standard Handover Technique to Transfer Patient Care? 2019

A quantitative study on personnel’s experiences with patient handovers between the operating room and the postoperative anesthesia care unit before and after the implementation of a structured communication tool. 2019

Improved Anesthesia Handoff After

Implementation of the Written Handoff

Anesthesia Tool (WHAT). 2018.

Improving post anesthesia care unit (PACU) handoff by implementing a succinct checklist. 2015.

Research Questions (Qualitative)/Hypothesis (Quantitative)

Why is a Standardized Approach Needed?

What is the Best Way to Standardize?

What Can We Learn From Other Industries?

“The use of a checklist during handovers could help providers correctly exchange information and increase the adequacy for nurse receivers.”

“The presence of many distractions

and lack of standardization detract from effective communication.” Handoff quality is improved in a structured format.

The article hypothesizes that there will be a substantial rise in the information exchanged, even with fewer checklist items.

A More concise checklist would allow for a more straightforward transformation into everyday operations and avoid the adverse response that similar checklists have previously received.

Purposes/Aim of Study

The study aims to establish critical challenges to handover communication, establish standardization need, how to implement and sustain quality improvement projects regarding handovers optimally.

The study aims to "explore the personnel's experience with patient's handovers quality between the operating room and the PACU before and after implementation of a tool targeting to refine communication during handovers." The article also aims to examine if there are different encounters with the handover quality among the transferring and receiving practitioners. The article investigates if factors like gender, age, years of experience, and professional background contribute to these differences.

Primarily the study aimed to barriers and omissions in anesthesia handoffs between “CRNAs and PACU RNs, and between CRNAs for breaks and case relief before and after implementation Written Handoff Anesthesia Tool.” Secondarily, the research aimed to improve satisfaction and perception regarding anesthesia handoff communication among the CRNAs and PACU RNs’.

The article aims to develop a concise checklist to help hasten the handoff process while escalating communication between anesthesia providers and PACU nurses.

Design (Type of Quantitative, or Type of Qualitative)

Narrative design

cross-sectional, quantitative design

quantitative pre-intervention-post-intervention

Design.

Cross-sectional design

Setting/Sample

Perioperative settings

The study was carried out in a health facility within a county in the Southeastern region of Norway. The sample consisted of 166 NAs, anesthesiologists, SNs, RNs, and CCNs before and 90 after the (ISBAR) - tool implementation.

350-bed hospital

in the Southeastern United States. The sample constituted of 22 CRNAs and 15 PACU RNs.

The sample was grouped into A and B. Group A with 14 residents and group B with 8 residents.

Methods: Intervention/Instruments

Observation

Questionnaire

Survey

Literature review and observation.

Analysis

The article establishes that communication is a crucial element for patients’ safety. The TJC report acknowledges breakdown in communication as the cause of anesthesia-related adverse events. The authors ascertain handover process is critical for safety among surgical patients. The omission of information has been arising from inconsistent guidelines accounting for 57% of the surgical mistakes/malpractice claims. The article establishes a need to obtain a standardized approach to account for conditions such as time pressures, quantity, and quality of the data during handover.

The data was analyzed using SPSS version 24, and answers were classified into negative and positive encounters. The sample's present features were presented using summative statistics, and the T-tests were utilized to avail before and after implementation differences among the personnel. The general linear regression model for age, gender, profession, and years of experience are used as independent variables and dependent variables being each statement to examine factors relating to experiences.

The TST program was used to calculate the handoff communication rate by proportional analysis. The handoff was defective if the receiver or sender established inadequacy due to patient data omission or other factors. The article demonstrates the inconsistency and quality of handoff as a significant communication problem between the receiver and the sender.

Information from previous studies was used to collect 42 items of the checklist, and practitioners' feedback was used to reduce it to 17. Actual PACU handoffs were used to measure the suggested checklist. The final checklist was prepared to address a two-way communication/ interaction between the anesthesia provider and the PACU nurse.

Key Findings

The research finds that standardizing communication reduces mortality and morbidity in surgical and medical settings. Improvement with medical errors is observable with the checklist implementation. The author ascertains that the “I-PASS Handover Bundle” reduces the rate of sentinel events occurring. Data transfer increases handover efficiency and improves nursing satisfaction. Besides, the article finds that distraction and personnel dynamics are central elements leading to handover failure and incomplete information transfer.

The article ascertains the were substantial contrasts between the transferring and receiving units before and after implementation based on age or experience. It is quicker to establish communication at the initial handover to resolve ambiguities and achieve complete documentation. Receiving nurses had more adverse experiences relating to completeness and availability of information. Using the ISBAR tool was supported by receiving nurses for better and safer handovers.

Inadequate information and inconsistency contribute to ineffective handoff communication. Standardization leads to adequate anesthesia handoff communication. Written tools improve anesthesia handoff communication's completeness and adequacy among the CRNAs and PACU RNs and CRNAs after implementing a structured instrument.

When using the checklist, PACU handoff items increased, and the amount of information rose. Antiemetic, Preoperative Cognitive Function, and Lines/catheters were highly missed by introducing a checklist show a reduction in morbidity and mortality.

Recommendations

The article suggests standardization of the handover using digital programs or apps, checklists, protocols, and mnemonics to mitigate potential harm during transfer.

Implementing a structured tool such as ISBAR for communication handovers would improve safety and quality between the operating room and PACU.

Implementing the TST programs would help identify and examine the contributing elements and solutions to improve handoff communication.

Implementing a standardized tool will improve handoffs and communication for comprehensiveness and efficiency.

Explanation of How the Article Supports EBP/Capstone Project

The article supports the Capstone project by providing essential and feasible information useful for the easy and accurate information transfer among the spinal patients who have received anesthesia for surgery. It suggests efficient technologies for EBP that ensure improved patient safety. It provides background information use in practice and to communicate in the critical parts where there are high-risk.

The article supports EBP by providing essential information that positively influences personnel experiences and promotes teamwork. It provides crucial data for improving innovation and optimality in the Capstone project to advocate for safety.

The study is relevant and essential for anesthesia groups searching for standardization and fosters, identifying, and evaluating the contributing factors, data omission, and communication procedures useful in EBPs.

This article supports EBPs, for it provides information relevant for teamwork and further research. Additionally, it creates a concrete foundation for the Capstone project by establishing a research gap (need for a standardized tool).

Criteria

Article 5

Article 6

Article 7

Article 8

Author, Journal (Peer-Reviewed), and

Permalink or Working Link to Access Article

Karamchandani, K., Fitzgerald, K., Carroll, D., Trauger, M. E., Ciccocioppo, L. A., Hess, W., Prozesky, J., & Armen, S. B., Quality Management in Health Care, and  https://doi.org/10.1097/qmh.0000000000000187

Park, L. S., Yang, G., Tan, K. S., Wong, C. H., Oskar, S., Borchardt, R. A., & Tollinche, L. E., Open Journal of Anesthesiology and https://doi.org/10.4236/ojanes.2017.74007

Fabila, T., Hee, H., Sultana, R., Assam, P., Kiew, A., & Chan, Y., Singapore Medical Journal, and https://doi.org/10.11622/smedj.2016090

Segall, N., Bonifacio, A. S., Barbeito, A., Schroeder, R. A., Perfect, S. R., Wright, M. C., Emery, J. D., Atkins, B. Z., Taekman, J. M., & Mark, J. B., The Joint Commission Journal on Quality and Patient Safety and  https://doi.org/10.1016/s15537250(16)42081-7.

Article Title and Year Published

A multidisciplinary handoff process to standardize the transfer of care between the intensive care unit and the operating room. 2018.

Does checklist implementation improve quantity of data transfer: An observation in Postanesthesia care unit (PACU). 2017.

Improving postoperative handover from anaesthetists to non-anaesthetists in a children’s intensive care unit: The receiver’s perception. 2016.

Operating room-to-ICU patient handovers: A multidisciplinary human-centered design approach. 2016.

Research Questions (Qualitative)/Hypothesis (Quantitative)

A conscientious multidisciplinary handoff from the ICU team to operating rooms teams is essential to improve patients’ safety by minimizing the risk of preventable harm.

“Physical checklist will improve data transfer and efficiency at PACU, and hinder omission of pertinent patient information in handoff.”

The customization or standardization of the handover process, SBAR form, and PETS protocol are essential to achieve information and workflow for the recipients (receiving teams).

The article hypothesizes that applying human-centered approaches would improve handover quality by decreasing staff workload, increasing staff satisfaction, increasing teamwork, and reducing interruptions within a short handover period.

Purposes/Aim of Study

This study aims to highlight the establishment and implementation of a hospital-wide quality improvement aspect/tool to improve outcomes and reduce patients’ harm.

The study suggests strategies for decreasing perioperative miscommunication and boosts patient safety by standardizing PACU handoff tools. Explore the use of checklists to enhance the quantity of data transferred in PACU handoffs.

The study aimed to examine the new handover process grounded on the recipients’ perceptions and based on the comprehensiveness and completeness of verbal communication and situation, background, assessment, and recommendation (SBAR) form utility.

The study aimed to apply a human-centered approach to restructure the OR-to-ICU patient handovers in a broad surgical intensive care unit population and examine the influence of handover quality.

Design (Type of Quantitative, or Type of Qualitative)

Observational

A cross-sectional observational study.

A cross-sectional observational study.

Ethnographic research design

Setting/Sample

550-bed academic, 18 pediatric critical care beds, tertiary care

center with 87 adult critical care beds across 4 adult ICUs and 42 neonatal critical care beds.

Memorial Sloan Kettering Cancer Center (MSKCC). Nurses, surgical staff, anesthesia staff, and PACU midlevel providers.

Cardiac Intensive Care Unit of KK Women’s and Children’s Hospital, Singapore. 52 CICU personnel, seven pediatric consultants, 44 nurses, and one rotating pediatric registrar.

Durham [North Carolina] Veterans Affairs (VA) Medical Center

Methods: Intervention/Instruments

Team Survey

Observation

Opinion survey

observations, surveys, interviews, and focus groups

Analysis

The patient transfer consists of two phases: ICU-to-OR and OR-to-ICU. On the ICU-to-OR transfer of care, the ICU team documents essential information, and handover to the anesthesia provider is initiated after TOFSO is announced. A verbal report is made, and there are opportunities to ask questions. The circulating nurse provides the ICU nurse with vital information on patients' condition on the and OR-to-ICU transfer of care. When the situation changes, the circulating nurses' updates the data. The surgeon and anesthesia nurse verify the successful handoffs, and the patient is transported to the ICU, and they provide complete information regarding the patient.

Pre-implementation took place in the first two weeks and post-implementation in the next two weeks. Before the research, the power calculation was initiated to establish the least recognizable difference to attain “80% and 90% power for a two-sided t-test” provided 50 patients in each set and 0.05 type I error. In the pre-implementation phase, the researchers assume five items mean and a standard deviation of 5. “The minimal detectable difference is 2.85 and 3.25 for 80% and 90% power.” This indicates a possible mean of 7.85 and 8.25 in the post-implementation phase. When S.D is reduced to 2, the changes are 1.14 and 1.30 for similar power. The tests were executed on two sides at the 0.05 alpha level using the Stata 13.

The study was examined in four phases: pre-intervention—intervention, implementation, and post-intervention. Pre-intervention involved evaluating handover protocols based on the situation, assessing recipient experience using the 5-point Likert scale, and SBAR was assessed. The second Phase entailed intervention encompassing modifying the existing practice in handoffs by building pre-handover, equipment handover, timeout, and sign out (PETS), mnemonic. The SBAR handoff document was integrated into PETS. The implementation entailed launching the new protocols-the post-intervention involved evaluating the newly integrated processes.

The t-test was applied to compared pre- and post-intervention handovers in the form of data transfer scores, interruptions, team behaviors score, task performance, period, and workload score. The survey score of 3 was the expected score, and the A p-value was 0.05. 

Key Findings

With the TOFSO process's overall compliance, zero serious safety threats relating to the transfer were reported. The TOFSO process improves consistency in team-care participation, reduces the knowledge deficit regarding the project.

The use of checklists boosted the overall quantity of data transferred during the PACU handoff. By using the checklists, there is a possible reduction in medical errors resulting from miscommunication and omissions.

The handover process's customization increased the sufficiency of the process, and face-to-face handover conveyed conciseness and clarity of the information. The agreement level between nurses after the customization found the handoff information sufficient, relevant, and essential.

By applying the new human-centered approaches, workload decreased, and teams behavioral scores increased significantly. The human-centered approaches provide comprehensive, virtuous, efficient, safe, and collaborative information handoffs.

Recommendations

There should be a development of novel and standardized procedures for transferring care in units within complex hospital environments.

Implementing a physical checklist for PACU handoff would prevent omission and increase the amount/quantity of data transfer. The healthcare should incorporate staff feedback in the Plan-Do-Study-Act cycles to improve the workforce’s familiarity and compliance in using checklists by providing multimodal training programs/modules.

The dual customization of handover process should be implemented to achieve the teams demand on workflow and information sufficiency. The SBAR handover document should be redesigned to obtain optimal information and unleash ambiguities.

PACU care should be redesigned to incorporate users, their work, and users’ interaction to inspire teamwork and essential communication.

Explanation of How the Article Supports EBP/Capstone

This article presents multidisciplinary collaboration as a pertinent concern for EBPs. The collaboration concerns aim to achieve safety and completeness of the information.

The article provides a feasible study for training and expanding the checklist content to achieve patient safety. The article supports the Capstone project for it allows for background information essential for justifying the use of checklists to improve communication by maximizing the quantity of transfer data.

The article supports the EBPs since it acknowledges the need for multidisciplinary operations at all points between operating rooms and the PACU. It supports the Capstone project by acknowledging every person's role in the handoff both at the sending and receiving ends.

The article is essential and supports EBPs by emphasizing team behaviors and teamwork. The research provides a comprehensive handover process and cognitive aid materials. The human-centered approaches/designs can successfully be utilized to develop and restructure bar-coded medication administration and implement nursing shift-change reviews.