Understanding Factors that Influence Anesthesia Handoffs
PI Elizabeth Lazzara
Communication is an essential aspect of quality patient care in modern medicine, yet mishaps in communication during handoffs (i.e., the transition of a patient between two or more providers) happen frequently. The purpose of this project was to understand the factors that influence handoffs between anesthesia providers and clinicians within the post anesthesia care unit.
Handoffs are ubiquitous in hospital settings and frequently occur before and after surgery (i.e. the perioperative setting). Because patient care in the perioperative setting is contingent upon communication between providers, it is important the handoff between surgical and post-surgical units occurs efficiently and efficaciously to ensure relevant patient information is being transferred. To ameliorate errors associated with handoffs, there is a national call for standardization (i.e., protocols). Although there has been progress in this domain, handoff research remains problematic. Protocols are often developed unscientifically, research methods lack rigor, and studies rarely compare protocols against one another. Additionally, many studies do not focus on contextual variables (e.g., noise or turn taking) or individual differences that could influence handoff efficiency.
To address this gap, this study utilized qualitative and quantitative methods to develop an innovative, customized, data-driven handoff protocol, implemented the protocol into a live perioperative setting, and evaluated it in comparison to the previously established handoff protocol, SBAR (Situation, Background, Assessment, and Recommendation).
We designed the handoff protocol using literature from the medical field, interviews, and a card sorting technique (a method to determine how experts organize their knowledge). Based on this data, we generated a protocol (i.e., Flex 12) and corresponding learning/training materials. We trained participants on Flex 12 using information- and practice-based strategies as well as feedback. More specifically, participants listened to a lecture on handoffs, had the opportunity to perform handoffs, and received feedback regarding their performance of those handoffs. To determine its effectiveness, the Flex 12 was tested using a pre-post within-subjects design, which means that all participants were measured before and after the Flex 12 was implemented.
Although handoff protocol was not significant with regards to handoff efficiency, noise and turn taking was significant. In other words, handoffs were less efficient when there was more noise from equipment or staff and when providers had more turns during their conversation. Finally, the use of the protocol impacted provider’s attitudes and cognitions. For example, providers perceived less authority between one another when the protocol was used.
Despite being a small study at one site, it does present evidence that other contextual factors should be considered to better understand handoffs. Factors, such as noise and turn-taking, do influence handoff outcomes (i.e., handoff efficiency). Considering the time demands placed on healthcare providers, it is critical to understand and maximize efficiency while maintaining safety.