An Operating Room to Intensive Care Unit Handoff That Is More Than a Handshake: A Quality Improvement Project.

Abstract

Interdisciplinary collaboration is a vital part of patient care. One of the most important aspects of care in the intensive care unit is the handoff process. Guided by the principles of High-Reliability Organizations, this process allows intra-professional and inter-professional sharing of critical patient information that can influence patient outcomes. The purpose of this project was to develop, implement, and evaluate the impact of a structured handoff process in the immediate postoperative recovery phase in the adult cardiothoracic intensive care unit (CTICU) in an academic medical center (AMC). The project focused on patients being transferred directly from the operating room (OR) to the CTICU with the goal of promoting efficiency, effectiveness, and optimizing the work environment. This was a nurse-led quality improvement project that took place over a 5-month period in a CTICU in an AMC. The project utilized the development of a comprehensive handoff process that included a staff position map and a handoff tool. Pre-post implementation unit-specific data were analyzed that includes staff workflow satisfaction surveys and financial savings to evaluate the outcomes of the handoff process. The CTICU handoff process helped reduce perceived OR patient turnover times and improved handoff efficiency, effectiveness, and readiness of providers at the point of care. The department will save a projected $25.5 K/annually by not interrupting the patient's arterial pressure monitoring system that was utilized in the OR. This CTICU handoff process has been shown to provide a seamless transition for the adult immediate postoperative patient. By providing standardized guidelines on communication, clarity of individual roles, and elimination of waste there is greater team member confidence in safety, completeness, and adaptability during handoff. Maintaining these improvements has required ongoing re-evaluation of the process including ongoing multidisciplinary education during the onboarding process. Overall, the implementation of this nurse-driven handoff process has proven to help efficiency, effectiveness and optimize the work environment and patient outcomes in a CTICU.