The Perioperative Handoff Toolkit
provides a step-by-step approach to conducting a patient transfer from the time that the patient arrives at the PACU or ICU from the operating room. The Toolkit fulfills all of the Joint Commission handoff criteria and standardizes an easy-to-follow 5-step protocol that provides for limited interruptions through its organized structure.
The Johns Hopkins Perioperative Handoff Toolkit Components Include:
- The 5-step perioperative protocol
- 18-Minute Protocol Training Video
- User Manual
+ Introduction About the Science of Safety, from Peter Pronovost
+ The Scientific Basis for the Handoff
+ The 5-Step Process for Creating Buy-in for the Handoff Protocol
+ Checklists for Verbal Reporting (Surgical, Anesthesiology and Nursing Providers)
The Johns Hopkins Perioperative Handoff Toolkit fulfills all of the Joint Commission handoff criteria. It standardizes an easy-to-follow 5-step protocol that provides for limited interruptions through its organized structure; describes a process that is reproducible and independent of the particular patient or providers involved, allowing for widespread applicability; defines an essential core team of handoff providers and directs their bedside presence, allowing opportunities for direct, interactive, real-time communication and face-to-face question clarification; provides, through anticipatory guidance, for the transfer of updated information on patient status with discussion of the most likely changes to that status; and provides a distinct start and end to the handoff, eliminating any ambiguity in designation of actual patient care transfer between the delivering and accepting teams.
The Johns Hopkins Perioperative Handoff Toolkit provides a 5-point protocol that standardizes patient handoffs between the surgical and recovery teams and five steps for securing hospital buy-in to adapt the protocol. Standardizing the perioperative handoff improves hospital safety at the point of transfer and can be adapted to fit the specific requirements of your hospital and your particular peri-procedural setting.
The Toolkit defines an essential core team of handoff providers, directs their bedside presence and instructs surgical/recovery teams on how to achieve direct, interactive, real-time communication and face-to-face question clarification.
What problems or objectives does this Solution address?
The problem is that mistakes are too often made when surgical teams transfer a post-op patient from surgery to the ICU or PACU. The problem arises because there's not usually a standard best practice in place and, therefore, vital communication is missed or misunderstood. Johns Hopkins Medicine clinical faculty developed and implemented a novel perioperative handoff protocol in the cardiac surgical ICU, which is now used as the standard of care throughout all of Johns Hopkins for adult perioperative handoffs.
What makes this Solution desirable?
This tool was initially piloted for patient transfers from the OR to the CSICU at the Johns Hopkins Hospital in 2009. In the ensuing months, its use spread across our hospital, and it is currently being used to conduct all adult perioperative handoffs from the OR to the intensive care units (ICUs) and recovery room areas (PACU).
Minor modifications have been made to the tool that highlight unique aspects of the local care issues. Some modifications include subspecialty-specific information, such as bypass times and heparin totals in the cardiac surgical ICU and intracranial pressure values in the neurosurgical ICU.
Were there any alternatives considered?
Many strategies have been proposed to improve overall handoffs in healthcare, but very little work has focused on the perioperative setting, during which the patient leaves the OR and arrives at a post-procedural destination, such as the post-anesthesia care unit (PACU) or intensive care unit (ICU).
How was this Solution developed?
In January 2009, we implemented a novel perioperative handoff protocol in the cardiac surgical intensive care unit (CSICU) of the Johns Hopkins Hospital. We first defined the process, and discovered that our institution's OR-to-ICU handoff process involves over 50 steps. We queried frontline providers as to the status of OR-to-ICU handoffs in the institution to determine shortcomings and areas for improvement.
To that end, we conducted hours of direct interviews with frontline providers and administered exploratory surveys that we created. We created a multidisciplinary focus group to discuss the feedback from the frontline providers and brainstorm possible solutions. Based on the interviews, surveys, and focus group sessions, we created a novel protocol for conducting OR-to-ICU handoffs that is centered on the use of two tools: a protocol format tool and a checklist to guide the content of surgical, anesthesia, and nursing reports.
Which Benchmark/Pertinent Metrics are recommended to use with this Solution?
- Participation by team members
- Patient Safety
- Participant Satisfaction
What are the prerequisites for a successful launch?
It is vital to secure institutional and departmental leadership support to ensure that implementation is a sustainable success. It also is important to create an implementation team (IPT) so that day-to-day healthcare providers at your institution become engaged in this process and can thereby ensure its success. It is then the responsibility of the IPT to train the respective personnel on this perioperative protocol.
What is the best way to measure Solution success?
Improved information sharing during handoffs; increased satisfaction of the receiving team; decreased distractions during a very vulnerable point in a patient's care; improved patient safety.
What are the key elements needed to SUSTAIN this Solution?
For the Perioperative Handoff Toolkit to be a long-term success, it requires periodic review to ensure that the use of the protocol is being sustained.