Evaluating the Impact of Intraoperative Surgical Team Handoffs on Patient Outcomes.

OBJECTIVE: The aim of the study was to assess the impact of intraoperative personnel handoffs on clinical outcomes in patients undergoing minimally invasive sacrocolpopexy (SCP). METHODS: We retrospectively reviewed SCPs performed at an academic center between 2009 and 2014. We analyzed the number of staff handoffs, defined as any instance a scrub technician (tech) or circulating nurse handed off responsibility for a break or shift change. Outcomes included operative (OR) time and composite variables for major complications (conversion to an open procedure, bladder injury, bowel injury, blood transfusion, infection, ileus, bowel obstruction, readmission, or mesh complication) and prolapse recurrence (prolapse at or beyond the hymen or retreatment). Postoperative complications were defined as being within 6 weeks of surgery. Mesh complications and prolapse recurrence were recorded for the entire 68-month study period. RESULTS: Of 814 patients, 97.4% were white, 85.3% postmenopausal, mean (SD) age 59.7 (8.8) years, and mean (SD) body mass index 27.5 (4.5) kg/m. Most had stage 3 prolapse (n = 563, 69.9%). There were 478 (58.7%) laparoscopic and 336 (41.3%) robotic SCPs. The median scrub tech and nurse handoff per case was 1.0 (interquartile range [IQR], 0.0-1.0) and 1.0 (IQR, 1.0-2.0), respectively. Mean (SD) OR time was 204.8 (69.0) minutes. One hundred twenty-nine patients (15.8%) had a major complication and 45 (7.5%) experienced prolapse recurrence over a median follow-up interval of 41.0 weeks (IQR, 12.0-101.0). On multivariable linear regression, each tech and nurse handoff was associated with an increased OR time of 13.6 (P < 0.001) and 9.4 minutes (P < 0.001), respectively. Thus, the median of 1 tech and 1 nurse handoff per case will increase OR time by 23.0 minutes (11.2%). On multivariable logistic regression, staff handoffs were not associated with major complications or prolapse recurrence. CONCLUSIONS: Intraoperative scrub technician and circulating nurse handoffs increased OR time for minimally invasive SCP procedures.

Quality improvement in health care: how to do it.

This article outlines the steps to success in quality improvement and explains how quality improvement can help you, your patients and your institution. Although many tactics can be used to drive quality improvement, some tactics deliver results that are short term and unsustainable and that fail to embed a culture of quality improvement within organizations. Consensus is emerging that a bottom-up approach may be better - where the intrinsic motivations of clinical staff are harnessed to drive quality improvement. This is an ideal opportunity for clinical staff at all levels to join in. The steps involved in quality improvement include choosing a topic, choosing tools to measure the problem, using plan, do, study, act cycles to drive improvement, and then writing up and sharing the project. Quality improvement projects can achieve multiple outcomes including improved patient experience and saved costs.

Impact of Physician Community Structure on Healthcare Outcomes.

There is a substantial variation in healthcare spending and readmission rate for individuals having admissions to different hospitals. This study assessed how the community structure of physician collaboration networks that evolve during the period of providing healthcare services to hospitalised patients contribute to this variation. A physician collaboration network is said to have a community structure if the nodes (i.e. physicians) of that network can be easily grouped into sets of nodes such that each set of nodes is densely connected internally but sparsely connected between groups. This study constructed physician collaboration networks based on patient-sharing ties among physicians who provided healthcare services to hospitalised patients. An administrative health insurance claim dataset was utilised to extract patient-sharing ties among physicians. Simple linear regression models were estimated to assess the impact of the community structure of physician collaboration networks on the healthcare outcome measures (i.e. readmission rate and hospitalisation cost). From these models, this study found that the structure of a physician community has significant impact on readmission rate and hospitalisation cost. Healthcare administrators or managers could consider this finding in developing effective and efficient healthcare environments in their respective healthcare organisations.

Utilizing bedside shift report to improve the effectiveness of shift handoff.

Handoff of patient information during shift report between nurses is a time of risk and liability. A quality improvement project was conducted on a 23-bed inpatient unit to measure the value of a bedside change-of-shift report in improving the effectiveness of shift report. Indicators including end-of-shift overtime, call light usage, nurse perceptions, and patient satisfaction were impacted by the change in process.

Using "warm handoffs" to link hospitalized smokers with tobacco treatment after discharge: study protocol of a randomized controlled trial.

BACKGROUND: Post-discharge support is a key component of effective treatment for hospitalized smokers, but few hospitals provide it. Many hospitals and care settings fax-refer smokers to quitlines for follow-up; however, less than half of fax-referred smokers are successfully contacted and enrolled in quitline services. "Warm handoff" is a novel approach to care transitions in which health care providers directly link patients with substance abuse problems with specialists, using face-to-face or phone transfer. Warm handoff achieves very high rates of treatment enrollment for these vulnerable groups. METHODS: The aim of this study-"EQUIP" (Enhancing Quitline Utilization among In-Patients)-is to determine the effectiveness, and cost-effectiveness, of warm handoff versus fax referral for linking hospitalized smokers with tobacco quitlines. This study employs a two-arm, individually randomized design. It is set in two large Kansas hospitals that have dedicated tobacco treatment interventionists on staff. At each site, smokers who wish to remain abstinent after discharge will be randomly assigned to groups. For patients in the fax group, staff will provide standard in-hospital intervention and will fax-refer patients to the state tobacco quitline for counseling post-discharge. For patients in the warm handoff group, staff will provide brief in-hospital intervention and immediate warm handoff: staff will call the state quitline, notify them that a warm handoff inpatient from Kansas is on the line, then transfer the call to the patients' mobile or bedside hospital phone for quitline enrollment and an initial counseling session. Following the quitline session, hospital staff provides a brief check-back visit. Outcome measures will be assessed at 1, 6, and 12 months post enrollment. Costs are measured to support cost-effectiveness analyses. We hypothesize that warm handoff, compared to fax referral, will improve care transitions for tobacco treatment, enroll more participants in quitline services, and lead to higher quit rates. We also hypothesize that warm handoff will be more cost-effective from a societal perspective. DISCUSSION: If successful, this project offers a low-cost solution for more efficiently linking millions of hospitalized smokers with effective outpatient treatment-smokers that might otherwise be lost in the transition to outpatient care. TRIAL REGISTRATION: Clinical Trials Registration NCT01305928.