Patient Bedside Handoff between the Post Anesthesia Care Unit and the Surgical Orthopedic Unit

Purpose:
The Post Anesthesia Care Unit (PACU) and the Surgical and Orthopedic Unit agreed to develop a process to ensure a safer handoff for postoperative patients. The process was also designed to promote face to face interaction between the nurses and the patient in a truly patient-centered handoff.

Significance:
Due to the fact handoffs pose great risk for patient safety and continuity of care, the teams developed a handoff process that occurs at the patient's bedside on the surgical unit. The teams then assessed the process to determine the impact on quality of care and patient perceptions.

Strategy and Implementation:
A new handoff process was developed between the units using the ISHAPED (I=Introduce, S=Story, H=History, A=Assessment, P=Plan, E=Error prevention, D=Dialogue) format that was developed in the Inova system. The patient centered handoff process began in March of 2011 and occurs between the nurse from the PACU and the nurse from the Surgical Unit at the patient's bedside on the surgical unit. This process includes information about the care of the patient in the PACU that is important for continuity in the care of the patient on the post-operative unit. The patient satisfaction results and core measure scores for patients undergoing surgical procedures Surgical Care Improvement Project (SCIP) were monitored pre- and post- implementation. Nurses used the ISHAPED tool as a means of including pertinent information and organizing patient care criteria that is shared.

Evaluation:
Patient satisfaction shows results above the 75th percentile for 2011. Centers for Medicare and Medicaid measure results of SCIP, and the results are more consistent and compliant with these measures. The compliance has risen to 95% consistently from results that were inconsistent and as low as 87%.

Implications for Practice:
The process improves collaborative nursing practice between departments and contributes to more consistent results in core measures. The process also positively impacts the patient's perception of safety and overall quality because of the transparency of the handoff.