Author:
Appelbaum Rachel D.,Puzio Thaddeus J.,Bauman Zachary,Asfaw Sofya,Spencer Audrey,Dumas Ryan P.,Kaur Kavneet,Cunningham Kyle W.,Butler Dale,Sawhney Jaswin S.,Gadomski Stephen,Horwood Chelsea R.,Stuever Mary,Sapp Alysha,Gandhi Rajesh,Freeman Jennifer
Abstract
BACKGROUND
The Joint Commission reports that at least half of communication breakdowns occur during handovers or transitions of care. There is no consensus on how best to approach the transfer of care within acute care surgery (ACS). We conduct a systematic review and meta-analysis of the current data on handoffs and transitions of care in ACS patients and evaluate the impact of standardization and formalized communication processes.
METHODS
Clinically relevant questions regarding handoffs and transitions of care with clearly defined patient Population(s), Intervention(s), Comparison(s), and appropriately selected Outcomes were determined. These centered around specific transitions of care within the setting of ACS, specifically perioperative interactions, emergency medical services and trauma team interactions, and intra/interfloor and intensive care unit (ICU) interactions. A systematic literature review and meta-analysis were conducted using the Grading of Recommendations Assessment, Development, and Evaluation methodology.
RESULTS
A total of 10 studies were identified for analysis. These included 5,113 patients in the standardized handoff group and 5,293 in the current process group. Standardized handoffs reduced handover errors for perioperative interactions and preventable adverse events for intra/interfloor and ICU interactions. There were insufficient data to evaluate outcomes of clinical complications and medical errors.
CONCLUSION
We conditionally recommend a standardized handoff in the field of ACS, including perioperative interactions, emergency medical services and trauma team interactions, and intra/interfloor and ICU interactions.
LEVEL OF EVIDENCE
Systematic Review/Meta-analysis; Level III.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Reference16 articles.
1. Patient safety in trauma: maximal impact management errors at a level I trauma center;J Trauma,2008
2. Six sigma methodology and postoperative information reporting: a multidisciplinary quality improvement study with interrupted time-series regression;J Surg Educ,2019
3. Patient handover from surgery to intensive care: using formula 1 pit-stop and aviation models to improve safety and quality;Paediatr Anaesth,2007
4. Standardized multidisciplinary protocol improves handover of cardiac surgery patients to the intensive care unit;Pediatr Crit Care Med,2011
5. The Eastern Association of the Surgery of Trauma approach to practice management guideline development using Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology;J Trauma Acute Care Surg,2012