Anesthesia Providers' Perceptions of Using a Patient Handoff Tool

Abstract

Up to 80% of serious medical errors occur due to miscommunication from one provider to another (The Joint Commission, 2012). In order to ensure ongoing safe patient care, it is imperative that anesthesia providers communicate effectively and consistently when transferring patient responsibility to other providers, especially to post-anesthesia care unit (PACU) nurses. Multiple patient transfers occur each day and patients are commonly transferred between multiple providers during the same hospital stay. These opportunities are extremely vulnerable to communication errors. Structured patient handoff checklists or tools increase the consistency of information transferred from anesthesia providers to other providers. The Joint Commission recommended in 2012 that all anesthesia providers utilize a standardized patient handoff checklist to increase and improve the quality of data transferred from anesthesia provider to the PACU nurse. Certified Registered Nurse Anesthetists (CRNA) at a local surgical unit provide the bulk of patient handoffs in this postoperative unit, and currently, there is no mandated use of a standardized handoff checklist. As a result, the CRNAs provide a verbal patient handoff that is unscripted. Verbal patient handoffs differ among providers due to individual provider preference. Without using a standardized handoff checklist, there is a risk of increasing communication errors which increase medical errors and negative patient outcomes. Salzwedel (et al., 2013), in a study when utilizing a handoff checklist, concluded that critical patient data conveyed during patient handoffs increased by 32.4% to 48.7% (Salzwedel et al., 2013). Tscholl et al. (2015) and McElroy et al. (2015) through surveys, determined that data transferred between anesthesia providers was more structured. Handoff checklists increased PACU nurse satisfaction regarding the overall handoff experience (McElroy et al., 2015). No studies, to date, were found that understand the perceptions and thoughts of CRNAs regarding the utilization of patient handoff checklists or tools in clinical practice. This Doctor of Nursing Practice (DNP) project assesses the perceptions and thoughts of utilizing standardized handoff checklists among CRNAs. The hope of this study is to better understand CRNA perceptions in order to identify potential barriers or knowledge gaps regarding the benefit of utilizing a standardized patient handoff checklists. Data from this project may be used to structure future quality improvement projects aimed at decreasing communication errors and improve patient outcomes. The results of this project show the majority of CRNAs (89.5%) surveyed for this project were already familiar with handoff checklists. However, only 26.3% of those same participants agreed they currently use a standardized patient handoff checklist. Of the surveyed participants, only 36.8% were interested in utilizing a standardized patient handoff tool even though nearly 50% agreed that using a handoff checklist would increase the consistency of information transferred from anesthesia provider to nurses. This correlates with the 73.7% of participants who already believe they currently transfer pertinent patient information successfully without utilizing a standardized handoff checklist or tool. Despite studies reporting improved patient outcomes, decreased medical errors, and the Joint Commission’s recommendations to use standardized handoff checklists or tools, the majority of anesthesia providers at this facility do not choose to use handoff checklists. By surveying anesthesia providers' thoughts and perceptions, the researcher attempted to answer why anesthesia providers are not utilizing handoff checklists in their daily routines.