Evaluation of postoperative handover using a tool to assess information transfer and teamwork.

OBJECTIVE: To assess the feasibility, validity, and reliability of a postoperative Handover Assessment Tool (PoHAT) and to evaluate the current practices of the postoperative handover at 2 large European hospitals. BACKGROUND: Postoperative handover is one of the most critical phases in the care of a patient undergoing surgery. However, handovers are largely informal and variable. A thorough understanding of the problem is necessary before safety solutions can be considered. METHODS: Postoperative Handover Assessment Tool (PoHAT) was developed through task analysis, semistructured interviews, literature review, and learned society guidelines. Subsequent validation was done by the Delphi technique. Feasibility and reliability were then evaluated by direct observation of handovers at 2 large European hospitals. Outcomes measures included information omissions, task errors, teamwork evaluation, duration of handover, and number of distractions. RESULTS: The tool was feasible to use and inter-rater reliability was excellent (r = 0.96, P < 0.001). Evaluation of handover at the 2 study sites revealed a median of 8 information omissions per handover at both the centers (IQR 7-10). There were a median of 3 task errors per handover (IQR 2-4). Thirty-five percent of handovers had distractions, which included competing demands for nurse attention, bleeps, and case-irrelevant communication. CONCLUSION: This study has established the feasibility, validity, and reliability of a tool for evaluating postoperative handover. In addition to serving as an objective measure of postoperative handover, the tool can also be used to evaluate the efficacy of any intervention developed to improve this process. The study has also shown that postoperative handover is characterized by incomplete transfer of information and failures in the performance of key tasks.

Postoperative handover: problems, pitfalls, and prevention of error.

OBJECTIVE: To identify the information transfer and communication problems in postoperative handover and to develop and validate a novel protocol for standardizing this communication. BACKGROUND: Effective clinical handover ensures continuity of patient care. Patient handovers within surgical units are largely informal. A thorough understanding of the problem is vital to develop standardized protocols. METHODS: A qualitative semistructured interview study was conducted with 18 healthcare professionals to uncover the problems with postoperative handover and to identify solutions, including components of a postoperative handover protocol. Interviews were recorded, transcribed verbatim, and submitted to emergent theme analysis. Multiple blind coders were used to ensure triangulation and reliability of the coding process. A Delphi method was used to elicit consensus from a group of 50 surgical professionals so as to validate the handover protocol. RESULTS: Many of the information transfer and communication failures at the postoperative phase are deemed to be due to an incomplete handover. All the interviewed healthcare professionals agreed that postoperative handover should be structured in the form of a standardized protocol so as to prevent omissions of any critical information. Based on this, 28 items were submitted to the Delphi process. Of these, 21 items had a mean importance score greater than 4.0 and were included in the final postoperative handover proforma under the following headings: patient-specific information, surgical information, and anesthetic information. CONCLUSION: The present study identified that the postoperative handover is informal, unstructured and inconsistent with often incomplete information transfer. Based on end-user input, a handover protocol was successfully developed and validated. Use of this may facilitate standardization of this critical activity and thereby improve the quality of patient care.

Occult spinal dysraphism: a challenge in pain management.

Spina bifida is a common birth defect affecting the central nervous system and represents a group of neural tube defects caused by congenital dysraphic malformations of the vertebral column and/or spinal cord. The anatomy in these patients is challenging and includes structural and vascular abnormalities including arteriovenous malformation or fistulae, and fatty substitution of paravertebral tissues. A magnetic resonance image (MRI) is needed for management of patients with lumbar radiculopathy and clinical features suspicious of occult spinal dysraphism. Risks and benefits of lumbar epidural steroids should be discussed comprehensively with those patients and in the best case scenario be avoided. Occult spinal dysraphism poses a clinical dilemma for interventional pain specialists managing those patients with lumbar radiculopathy. We report a case of occult spinal dysraphism discovered following the development of post-traumatic radicular symptoms.

Improving postoperative handover: a prospective observational study.

BACKGROUND: The information provided during the postoperative handover influences the delivery of care of patients in the postoperative recovery unit through their care on the ward. There is a need for a structured and systematic approach to postoperative handover. The aim of this study was to improve postoperative handover through the implementation of a new handover protocol, which involved a handover proforma and standardization of the handover process. METHODS: This prospective pre-post intervention study demonstrated the improvement in postoperative handover through standardization. There was a significant reduction in information omissions and task errors and improvement in communication and teamwork with the new handover protocol. RESULTS: There was a significant reduction in overall information omissions from 9 to 3 (P < .001) omissions per handover and task errors from 2.8 to .8 (P < .001) with the new handover protocol. Teamwork and nurses' satisfaction score significantly improved from a median of 3 to 4 (P < .001) and median of 4 to 5 (P < .001). Duration of handover decreased from a median of 8 to 7 minutes (P < .376). CONCLUSIONS: The study demonstrates that standardization of postoperative handover improved communication and teamwork and reduced information omissions and task errors. There was an improvement in the quality of the handover after the introduction of the new handover protocol, which was easy and simple to use.