From Here to There: Hand-Off and Huddle

Purpose:
Safe care for Neonatal general surgery & Pediatric cardiac surgery patients require an organized approach to communication & hand-off,as well as a reduction in variability.UVA Children's Hospital sought to improve outcomes with a formalized hand-off of care program with improved standardization.

Significance:
Several near misses occurred as a result of incomplete communication, process variation & parent education.The new process requires detailed steps be completed by interdisciplinary teams before & after surgery. For success,the process must be well defined,understood, followed & measured.

Strategy and Implementation:
Two teams were formed to critically evaluate the hand-off of care process: Surgical Services & the Neonatal Intensive Care Unit (NICU) & the Pediatric Intensive Care Unit (PICU). The NICU team completed a gap analysis,identified root causes & created a new "check & verify" process to reduce practice variability. An interdisciplinary checklist was created to guide teams through a process that begins the day prior to surgery & ends with a post-op team huddle upon arrival to the NICU. The PICU identified opportunities for improvement & used lessons learned from NICU to develop a new process & checklist. It begins with a call from the Anesthesiologist to the admitting PICU RN at the end of surgery & finishes with a post-op huddle after a "time out-step back" which allows un-interupted time upon arrival to PICU. Each individual process was simulated, fine-tuned, measured & analyzed with a pilot study before implementation.

Evaluation:
Post pilot results NICU 100%adherence:pre-op orders & parent communication 75-100%adherence:team communications >90%adherence:central line care PICU 88%adherence:team communication >90%adherence:central line care 100%accuracy&completion of postop Anesthesia note prior to PICU arrival

Implications for Practice:
Quality improvement methodology can be used to reduce variability & improve team communication.Teams that adhere to a standard hand-off process & continuously measure & evaluate these,produce good outcomes.These improvements can be customized to meet the needs of surgical patients in other venues.