Improved Communication in Anesthesia Patient Transfers of Care

Primary Author:	Lois L. Bready, MD
Co-Principal Investigators/Collaborators:	J. J. Andrews, E. Boatman, E. Wong, L. Davis, J. Sulser, S. Stevens, A. Parekh, N. Schafer, M. Ingram
Organization:	UT Health Science Center San Antonio

Abstract

Introduction

An estimated 80 percent of serious medical errors involve miscommunication between caregivers when patients are transferred or handed-off, and TJC requires the use of a standardized approach to hand-off communications. Multiple checklists exist for transfers of care (TOC) in anesthesia practice. An ideal TOC process is succinct, driven by a written checklist, and may be modified for short vs. terminal TOC. At the time of this study, standard practice for anesthesia providers at our institution was a short verbal transfer of care from the outgoing to the incoming provider.

Methods

A list of patient information elements was created from multiple handoff protocols, and was prioritized, stratified, and condensed by the Workgroup for the Development of Transfer of Care (TOC) Guidelines for Anesthesia Professionals of the American Society of Anesthesiologists Patient Safety Committee and by our process improvement team. Eighteen elements were identified as essential. Using this 18-element checklist , a process improvement study was conducted over a four-month period.

Baseline

Providers (anesthesiology CA-1-3 residents, CRNAs) gave their customary verbal TOCs based on their idea of what was essential patient information. Observers documented number of essential data elements transmitted, using the checklist as an audit tool.

Intervention

An education intervention was made to introduce the written checklist of to guide TOCs and rationale for its use. TOCs were observed after checklist implementation. The IRB considered this process improvement project to be exempt.

Results

Baseline communication of essential elements was 50%. After intervention (educational and checklist), the rate of communication of essential elements increased to 93%.

Conclusion

Implementation of a written checklist to guide TOC resulted in a near doubling of communication of essential information elements between anesthesia providers.

Bibliography

Joint Commission of Accreditation of Healthcare Organizations: 2007 National Patient Safety Goals Hospital Version Manual Chapter, including Implementation Expectations.
Volpp K.G., Grande D.: Residents’ suggestions for reducing errors in teaching hospitals. N Engl J Med 348:851-855, Feb 27, 2003.
Cook R.I., Render M., Woods D.D.: Gaps in the continuity of care and progress on patient safety. BMJ 320:791-794, Mar 18 2000.
Arora V., et al.: Communication failures in patient signout and suggestions for improvement: a critical incident analysis. Qual Saf Health Care 2005 Dec14:401-407.
O’Byrne WT 3rd, Weavind L, Selby J. The science and economics of improving clinical communication. Anesthesiol Clin. 2008 Dec;26(4):729-44, vii.
Manser T, Foster S, Gisin S, Jaeckel D, Ummenhofer W. Assessing the quality of patient handoffs at care transitions. Qual Saf Health Care. 2010 Dec;19(6):e44.