Improving the Reliability of the Clements University Hospital OR to CV-ICU Patient Handover Observer Training Program

OR to CV-ICU patient handovers reflect high risk clinical scenarios where providers must transfer patient care responsibilities in the safest possible way. These post-sternotomy handovers are error prone, as providers must exchange patient information in a busy and chaotic environment while simultaneously stabilizing the often tenuous patient who requires hemodynamic and cardiopulmonary support. At UT Southwestern's University hospital, patient handoffs and transitions of care have less than a 50% approval rating per HSOPS data, suggesting a serious need for improving patient handovers. The Clements University Hospital (CUH) OR to CV-ICU observer training program was developed to train a cohort of clinicians who can evaluate post-sternotomy handovers and subsequently make recommendations for improving these handovers. The aim of this project is to improve the reliability and user satisfaction of the existing CUH OR to CV-ICU patient handover observer training program by January 2017. The performance results of the six observers who underwent the first iteration of the observer training program were reviewed. All six observers achieved greater than 80% agreement with the faculty expert, or master key, in their evaluation of handover scenarios from the training videos, suggesting an adequate understanding of how to evaluate a OR to CV-ICU handover. However, observers did not achieve a sufficient inter-rater reliability, with a suboptimal average Fleiss' kappa of 0.65. Since sufficient percent agreement and inter-rater reliability are both required to deem observers appropriately trained, these six observers did not meet the criteria to become 'trained observers.' To understand observers' challenges and overall satisfaction with the training program, a focus group analysis was performed. Elements critical-to-quality for the observer were identified, which included better teaching of handover best practice requirements so observers can more confidently evaluate the handovers.