ISBAR as a Structured Tool for Patient Handover During Postoperative Recovery.

PURPOSE: The purpose of this study was to investigate interaction in the handovers between anesthesia and the recovery room and to examine the effect of using the Identification, Situation, Background, Analysis, and Recommendation (ISBAR) instrument as a structured dialogue tool during hand over. DESIGN: A prospective quality improvement project with pre/post assessment. METHODS: Fifty handovers in the postanaesthesia care unit were observed. Data were collected regarding parameters associated with ISBAR. Both certified registered nurse anesthetists and registered nurses (RNs) from postanaesthesia care unit were subsequently asked about their satisfaction with the handover via an electronic questionnaire survey. After 6 months, the questionnaire survey was repeated, and 50 observations were conducted identical to the baseline observations. FINDINGS: Results showed that from baseline to follow-up, RNs were more prepared to receive the patient (from 84% to 95%), read the patient records more frequently (from 18% to 54%), and were assigned to patients from the start of the day (from 86% to 100%). The content of the oral handover was more structured using the ISBAR, and handovers became more concentrated and undisturbed (from 12% to 86%). At baseline, certified registered nurse anesthetists were more satisfied with the handover than RNs (38% difference). At the follow-up, there was no discrepancy between the two groups. CONCLUSIONS: Knowledge and focus on the verbal handover influence communication, team effectiveness, and quality of handovers. The ISBAR structured approach reduced disturbances to handover because everybody involved had a clear expectation of the different items to be reviewed and were less likely to interrupt to question or clarify. Using ISBAR as a structured tool along with organizational changes can improve the quality of patient handover and thereby improve patient safety.

Has perinatal outcome improved after introduction of a guideline in favour of routine induction and increased surveillance prior to 42 weeks of gestation?: A cross-sectional population-based registry study.

OBJECTIVE: To investigate whether new national guidelines of routine induction of labour and increased surveillance in low risk pregnancies at 41+2-5 weeks of gestation as an alternative to expectant management until 42+0 weeks of gestation has improved perinatal outcome. METHODS: A questionnaire-based study regarding local induction practices among all Danish delivery units and a cross-sectional population-based registry study based on data from the Danish Medical Birth Registry (DMBR) in the years 2009-2012. OUTCOME MEASURES: Primary outcomes were frequencies of induced labour and perinatal mortality; secondary outcomes were indicators of perinatal morbidity and instrumental delivery rates. RESULTS: The questionnaire data showed that 22 of the 24 Danish delivery units complied with the new guidelines in 2012. The study population retrieved from the DMBR included 36,845 low-risk pregnancies at or beyond 41+2 weeks of gestation. The number of labour inductions within the study population had doubled after implementation of the new guideline. The increased proportion of induced labour did not appear to influence perinatal morbidity or instrumental delivery rates. Perinatal mortality remained steady in the years 2009, 2010 and 2011 whereas a reduction of 60 % was seen in 2012. However, this change was not statistically significant (P = 0.10). CONCLUSION: This population-based study with a high reported adherence to the new national guideline found no changes in instrumental deliveries or perinatal outcomes after implementation of earlier routine induction of labour and increased surveillance in low risk pregnancies.