Handover after pediatric heart surgery: A simple tool improves information exchange

Abstract

OBJECTIVE:: To improve the quality of handover of complex patients after pediatric cardiac surgery through the use of a simple handover tool. DESIGN:: Prospective, pre-/postinterventional. SETTING:: A tertiary care, pediatric intensive care unit in North America. SUBJECTS:: Thirty-three consenting healthcare providers from pediatric cardiac anesthesia, critical care, and cardiothoracic surgery participating in 31 handovers. INTERVENTION:: A fill-in-the-blank, one-page tool was developed to guide the information transmitted by the surgeon and anesthesiologist to the pediatric intensive care unit team during handover of postcardiac surgery patients. MEASUREMENTS AND MAIN RESULTS:: Total handover score, four subscores, handover duration, and postoperative high-risk events were measured before and after introducing the tool into clinical practice. The patients in both the pre- and postintervention groups were similar at baseline. The total handover score (maximum 43 points) improved significantly after the implementation of the handover tool (28.2 of 43 ± 4.6 points vs. 33.5 of 43 ± 3.7 points, p = .002). There was also a significant improvement in the medical (8.3 ± 2.6 vs. 10.3 ± 2.1 points, p = .024) and surgical (7.5 ± 1.4 vs. 9.3 ± 1.6 points, p = .002) intraoperative information subscores. Use of the tool did not prolong handover duration (8.3 ± 4.6 vs. 11.1 ± 3.9 mins, p = .1). There was a trend toward more patients being free from high-risk events in the postintervention group (31.2% vs. 6.7%), but this did not reach statistical significance (p = .1). CONCLUSIONS:: Use of a simple tool during handover of pediatric postcardiac surgery patients resulted in a more complete exchange of critical information with no significant prolongation of the handover duration. Copyright © 2011 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.