Improving Communication and Handoff Between the Operating Room and NICU

Purpose:
The goal is to improve the quality of communication and decrease time spent giving handoff between the Operating Room and the Neonatal Intensive Care Unit. Prior state noted lack of standardization, poorly defined roles that lead to distrust, misinformation, and report being given multiple times.

Relevance/Significance:
A multidisciplinary team was formed with the goal of improving communication through a standardized process and use of a handoff checklist. Checklists have been shown to increase patient safety in many realms of healthcare. This best practice allows for streamlining of the handoff process which in turn allows for a report that is thorough, efficient, and that eliminates the possibility of missed or forgotten information.

Strategy and Implementation:
A multidisciplinary group was formed and observations and video of the existing state of the handoff process were performed. Average handoff time was 18.8 minutes. Other prior state observations were that the report had no clear beginning or end and was given multiple times by the same provider. Work appeared to continue while handoff report was being given. Large differences in lead time for patient arrival back to the NICU were also noted. A survey was sent to staff and 62% replied that they believe deficits existed in the current process of OR to NICU handoff. Based on survey responses, an ideal process was drafted and an existing checklist was revised. A tabletop walk through of the new process was done and staff was educated. The new process involved using the checklist to relay relevant information, a specific order of who gives report, and a process for notification of patient return in order to assemble all necessary staff to hear report one time.

Evaluation:
Evaluation was done by direct observations. Time spent giving report decreased from 18.6 minutes to 6.53 minutes. The checklist was used 88% of the time, and the team waited until the patient was settled and the bedside nurse could be attentive to the report 88% of the time. A re-survey of staff is planned and on-going education will be provided in order to ensure that the process continues.

Implications for Practice:
Use of the checklist and gathering the NICU team members in one place for one report decreased the time spent and improved report quality. Streamlining the handoff process allows for report to be given one time to an attentive audience, and a better quality report allows for improved patient safety.