PC1223: Improving Perioperative Handoff in the Neonatal Intensive Care Unit

Purpose/Objectives: Lack of effective communication is a common attributable cause of preventable medical errors during patient handovers. Specifically, in a Neonatal Intensive Care Unit (NICU) setting, there is a lack of defined perioperative handoff tools to facilitate communication available in the literature. The purpose of our quality improvement (QI) initiative was to assess the potential impact of implementing a checklist to standardize patient handovers between multidisciplinary teams in the NICU. Our aim is by July 2021, >70% of postoperative neonates admitted to the NICU will have documentation of an interprofessional postoperative handoff occurring within 1 hour of surgery.

Design/Methods: The study was conducted as a QI initiative using the Institute for Healthcare Improvement’s Model for Improvement in a Level 4 NICU at an academic hospital from July 2020 to October 2021. Our study utilized four Plan-Do-Study-Act (PDSA) cycles that included the creation and implementation of a templated preoperative and postoperative checklist and handoff notes to address our key drivers consisting of standardize handoffs, interdisciplinary team engagement, and documentation. Handoffs were documented within the electronic medical record (EMR). Our process measures include a visual aid with consensus decision on roles and responsibilities for team members during each postoperative handoff, documentation of the postoperative handoff, education of stakeholders, and quarterly feedback. Our outcome measures included handoff documentation compliance in EMR while our balancing measures included duration of handoff. Qualitative feedback was elicited through an electronic survey sent out through a standardized email template and a QR code located on the handoff checklist.

Results: A total of 113 cases were completed by the pediatric surgery service over a 15-month period in the NICU. Compliance with postoperative handoff documentation was consistently >70% following implementation of our 2nd PDSA cycle and compliance with preoperative handoff documentation was consistently >70% following implementation of our 4th PDSA cycle. After education and implementation of the standardized preoperative handoff, compliance rose to 100%. The average time to complete bedside postoperative handoff was approximately 9 minutes.

Conclusion/Discussion: Implementation of our QI initiative assisted in standardizing patient handovers and improved perioperative handoff documentation. Key components to the success of our QI initiative include the creation of a checklist and visual aid that delineates roles and responsibilities for team members during a postoperative handoff, creation of a templated handoff note in EMR, key stakeholder buy-in, and consistent feedback.