Standardizing the Intra-Operative Handover Between Faculty Anesthesiologists Using an EMR-Based Tool

SHORT DESCRIPTION: The primary aim of this project is to improve faculty satisfaction with a newly implemented intra-operative handoff tool. The secondary aim is to increase the effectiveness of the intra-operative handoffs by creating a user-friendly electronic medical record (EMR)-based cognitive aid designed to improve the reliability of this process. BACKGROUND: Communication failures during intra-operative handoffs can lead to adverse events and poor patient outcomes [1]. Faculty anesthesiologists frequently perform intra-operative handoffs as a part of their patient care responsibilities. While handoffs have garnered international attention calling for standardization [2,3], there are currently few specific recommendations on how intra-operative handoff should be completed. Checklists in the electronic medical record (EMR) have been shown to be effective in improving relay and retention of critical patient information during intra-operative transfers of care [3]. However, the essential elements and qualities in an intra-operative handoff tool have not been explored. This project identified the attributes in an EMR-based intra-operative handoff tool that are critical to faculty anesthesiologists at UT Southwestern Medical Center (UTSW). METHODS: Faculty anesthesiologists were interviewed for thoughts and comments about the current intra-operative handoff tool implemented at UTSW. Qualitative interview responses were separated into unique comments and analyzed for common themes. Quantitative results on opinions about current process handoff process and tool were determined. Critical-to-quality elements for effective intra-operative handoff tool were extracted from interview responses. EVALUATION AND OUTCOMES: Faculty had mixed opinions about current intra-operative handoff process, and most were unsatisfied about current handoff tool. From one-on-one interviews to explore faculty opinion, a total of 80 unique comments were generated regarding the tool, and 4 main themes were identified: patient information, tool functionality, data organization, and implementation. A total of 17 subtopics were identified based on comments. 15 critical-to-quality in an intra-operative tool was identified. IMPACT AND LESSONS LEARNED: Detailed faculty opinion and feedback regarding current intra-operative handoff process and tool at our institution were collected. Key critical-to-quality elements for an effective intra-operative handoff tool were identified and a proposed tool was created based on feedback. Further work will focus on working with electronic medical record system to develop updated and "ideal" tool based on results of this study. REFERENCES:

1. Commission, J. & Others. Improving America's hospitals: The Joint Commission's annual report on quality and safety. The Joint Commission, Oakbrook Terrace (2007).
2. The Joint Commision. "Sentinel Event Alert 58:Inadequate Hand-off Communication." Jointcommission.org, 11 Sept. 2017, www.jointcommission.org/sentinel_event_alert_58_inadequate_handoff_communications/, Accessed March 8, 2018.
3. World Health Organization Collaborating Center for Patient Safety: Communication during Patient Handovers. Geneva, Switzerland, WHO Press; 2007. Available at: http://www.who.int/patientsafety/solutions/high5s/High5_overview.pdf
4. Agarwala, Aalok V., et al. "An Electronic Checklist Improves Transfer and Retention of Critical Information at Intraoperative Handoff of Care." Anesthesia & Analgesia, vol. 120, no. 1, 2015, pp. 96-104., doi:10.1213/ane.0000000000000506.