The Effectiveness of an Anesthesia Handoff Tool: An Electronic Health Record Application to Enhance Patient Safety

  • Karen Elizabeth Gillikin, MSN, MSNA DNP, CRNA Old Dominion University
  • Nathaniel Apatov, MSN, MHS, PhD, CRNA Old Dominion University School of Nursing

Abstract

Perioperative patient care handoffs are complex and multidimensional and require accurate attention to detail. Communication failures among healthcare providers increase the risk of morbidity and mortality. Utilizing a standardized handoff tool located within the electronic anesthesia record formalizes the handoff process and improves patient safety. Prior to the introduction of the Electronic Anesthesia Handoff Tool, 82 patient care transfer observations were conducted; subsequent to the launch of the tool, 75 patient care transfer observations were conducted, and then before and after comparisons were made. Descriptive statistics, a two-tailed t-test, and Spearman’s correlations were conducted. Alpha level was set at p < 0.05. There were significantly (p<.05) fewer errors made in all categories of patient information following the introduction of the Electronic Anesthesia Handoff Tool. Though there were trends towards more omissions occurring after 3:00 p.m., the difference in most patient information categories was not significant (p>.05). In addition, there were no differences in omissions related to the severity of patient co-morbidities based on patients’ American Society of Anesthesiologists physical status classification. This study provided information regarding the incidence of patient information inaccuracies and omissions during patient care transfer before and after implementation of an electronic patient care transfer tool. 

Author Biographies

Karen Elizabeth Gillikin, MSN, MSNA DNP, CRNA, Old Dominion University

Karen Gillikin, MSN, MSNA DNP, CRNA, is an Associate Director at Old Dominion University School of Nursing, Nurse Anesthesia Program, Norfolk, VA. She also works as a staff CRNA for Sentara Medical Group, Hampton, VA.

Nathaniel Apatov, MSN, MHS, PhD, CRNA, Old Dominion University School of Nursing
Director at Old Dominion University School of Nursing, Nurse Anesthesia Program, Norfolk, VA.  He also works as a staff CRNA for Bon Secours DePaul Hospital, Norfolk, VA

References

1. Goldsmith D, Boomhower M, Lancaster DR, et al. Development of a nursing handoff tool: A web-based application to enhance patient safety. AMIA Annual Symposium Proceedings Archive. 2010. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3041387/. Accessed January 8, 2013.

2. Jayaswal S, Berry L, Leopold R, et al. Evaluating safety of handoffs between anesthesia care providers. The Ochsner Journal, 2011;11(2):99-101.

3. Petrovic MA, Aboutmar H, Baumgartner WA, et al. Pilot implementation of a perioperative protocol to guide operating room-to-intensive care unit patient handoffs. J Cardiothor Vasc An. 2012;26(1):11-16.

4. Hudson, CCC, McDonald, B, Hudson, JKC, Tran, D, et al. Impact of anesthetic handover on mortality and morbidity in cardiac surgery: A cohort study. J Cardiothor Vasc An. 2015; 29(1):11-16.

5. Catchpole KR, DeLaval MR, McEwan A, et al. Patient handover from surgery to intensive care unit: Using Formula 1 pit-stop and aviation models to improve safety and quality. Pediatr Anesth., 2007;17:470-478.

6. Wright MC, Phillips-Bute B, Mark JB, et al. Time of day effects on the incidence of anesthetic adverse events. Quality Safe Healthcare, 2006;15(4):258-263. doi:10.1136/qshc.2005.017566.

7. Scott LD, Rogers AE, Hwang W, Zhang Y. Effects of critical care nurses’ work on vigilance and patients’ safety. Am J Crit Care, 2006;15(1):30-37. http://ajcc.aacnjournals.org/content/15/1/30.long. Accessed January 12, 2013.

8. Arevalo JD. Anesthetic adverse events vary based on time of day. Anesthesia Zone Web site. http://www.anesthesiazone.com/featured-newsarticle.aspx?id=2366. Updated 2007. Accessed January 8, 2013.

9. Patient Safety Primer: Handoffs and Signouts. AHRQ Patient Safety Network Web site. http://www.psnet.ahrq.gov/primer.aspx?primerID=9. Updated October 2012. Accessed January 8, 2013.

10. Wright S. Examining transfer of care processes in nurse anesthesia practice: Introducing the PATIENT protocol. American Association of Nurse Anesthetists Journal, 2013;81(3):225-232.

11. Bosman RJ. Impact of computerized information systems on workload in operating room and intensive care unit. Best Pract Res Cl Anaesthesiology. 2009;23:15-26.

12. Van Eaton EG, Hovarth KD, Lober WB, Pellegrini CA. A randomized, controlled trial evaluating the impact of a computerized rounding and sign-out system on continuity of care and resident work hours. J Am Coll Surgeons. 2005;200:538-545.

13. Christian C, Gustafson M, Roth E, et al. A prospective study of patient safety in the operating room. Surgery. 2005;139(2):159-173.

14. Cohen MD, Hilligoss PB. Handoffs in hospitals: A review of the literature on information exchange while transferring patient responsibility or control. 2009. Deep Blue Web site. http://deepblue.lib.umich.edu/handle/2027.42/61498?show=full. Accessed January 12, 2013

15. Institute of Medicine. Crossing the quality chasm: A new health system for the 21st century. Washington, DC: National Academy Press; 2001.

16. Wakefield MK. The quality chasm series: Implications for nursing. In: Hughes RG, ed. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville: Agency for Healthcare Quality and Research, 2008. http://www.ncbi.nlm.nih.gov/books/NBK2651/. Accessed January 12, 2013.
Published
2016-05-13
How to Cite
GILLIKIN, MSN, MSNA DNP, CRNA, Karen Elizabeth; APATOV, MSN, MHS, PHD, CRNA, Nathaniel. The Effectiveness of an Anesthesia Handoff Tool: An Electronic Health Record Application to Enhance Patient Safety. Anesthesia eJournal, [S.l.], v. 4, n. 1, may 2016. ISSN 2333-2611. Available at: <https://anesthesiaejournal.com/index.php/aej/article/view/45>. Date accessed: 24 feb. 2020.
Section
Articles

Keywords

Anesthesia handoff, electronic health record, patient care transfer.