Implementation of a standardized handoff protocol for post-operative admissions to the surgical intensive care unit.

BACKGROUND: The transfer of critically ill patients from the operating room (OR) to the surgical intensive care unit (SICU) involves handoffs between multiple providers. Incomplete handoffs lead to poor communication, a major contributor to sentinel events. Our aim was to determine whether handoff standardization led to improvements in caregiver involvement and communication. METHODS: A prospective intervention study was designed to observe thirty one patient handoffs from OR to SICU for 49 critical parameters including caregiver presence, peri-operative details, and time required to complete key steps. Following a six month implementation period, thirty one handoffs were observed to determine improvement. RESULTS: A significant improvement in presence of physician providers including intensivists and surgeons was observed (p = 0.0004 and p < 0.0001, respectively). Critical details were communicated more consistently, including procedure performed (p = 0.0048), complications (p < 0.0001), difficult airways (p < 0.0001), ventilator settings (p < 0.0001) and pressor requirements (p = 0.0134). Conversely, handoff duration did not increase significantly (p = 0.22). CONCLUSIONS: Implementation of a standardized protocol for handoffs between OR and SICU significantly improved caregiver involvement and reduced information omission without affecting provider time commitment.

Comparison of the endotracheal cardiac output monitor to thermodilution in cardiac surgery patients.

OBJECTIVES: To compare cardiac output (CO) measurements from a novel endotracheal bioimpedance cardiac output monitor device (ECOM; ConMed, Irvine, CA) to simultaneous pulmonary artery thermodilution (TD) CO. DESIGN: Prospective study. SETTING: One academic hospital. PARTICIPANTS: Forty volunteer patients undergoing cardiac surgery. INTERVENTIONS: Intraoperative CO measurements. MEASUREMENTS AND MAIN RESULTS: Simultaneous comparative data points were collected from ECOM and TD at 4 periods: post-induction, post-sternotomy, post-cardiopulmonary bypass, and post-chest closure. The mean CO(TD) was compared with CO(ECOM) for each operative period then assessed for agreement by linear regression, Bland-Altman analysis, and percent error methods. There were 35 men (87.5%) with a mean age of 66 ± 10.7 years in the present study population. R values (p value) for the 4 time periods were 0.50 (0.002), 0.33 (0.035), 0.42 (0.007), and 0.48 (0.002). Bias and 95% limits of agreement in L/min were -0.11 (-2.40 to 2.18), 0.04 (-2.57 to 2.65), -0.06 (-2.86 to 2.74), and 0.02 (-2.42 to 2.45). Percent errors of the 4 time periods were 51%, 53%, 50%, and 48%. CONCLUSIONS: ECOM did not adequately agree with TD in patients undergoing cardiac surgery.