Background

Patient handoffs from an operating room (OR) to an intensive care unit (ICU) require precise coordination among surgical, anesthesia, and critical care teams. Although several standardized handoff strategies have been developed, their sustainability remains is poor. Little is known regarding factors that impede handoff standardization.

Purpose

Our objectives are three-fold: (1) highlight compliance failures with standardized handoffs; (2) identify factors contributing to compliance failures; and (3) develop guidelines for sustainable handoff interventions and processes.

Methods

We used ethnographic data collection methods—general observations, handoff shadowing, and semi-structured clinician interviews—with 84 participants from OR, ICU, and telemedicine teams at a large academic medical center. We conducted thematic analysis supported by inductive and deductive coding using the Systems Engineering Initiative for Patient Safety (SEIPS) framework.

Results

Post-operative handoffs can be characterized into four phases: pre-transfer preparation, transfer and setup, report preparation and delivery, and post-transfer care. We identified compliance failures with standardized handoff protocols and associated risk factors within the OR-ICU work system including limited teamwork, absence of handoff-specific tools, and poor clinician buy-in. To improve handoffs, clinicians provided suggestions for developing collaborative Electronic Health Record (EHR)-integrated handoff tools and re-engineering the handoff process.

Conclusions

Compliance failures are prevalent in all handoff phases, leading to poor adherence with standardization. We propose theoretically grounded guidelines for designing "flexibly standardized" bundled handoff interventions for ensuring care continuity in OR to ICU transitions of care.

中文翻译：

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术后移交标准化失败的观察研究

背景

从手术室（OR）到重症监护室（ICU）的患者移交需要手术，麻醉和重症监护团队之间的精确协调。尽管已经开发了几种标准化的切换策略，但是它们的可持续性仍然很差。关于阻碍切换标准化的因素知之甚少。

目的

我们的目标有三方面：（1）通过标准化的移交突出合规性失败；（2）找出导致合规性失败的因素；（3）制定可持续切换干预措施和流程的指南。

方法

我们使用人种学数据收集方法-总体观察，越区切换阴影和半结构化临床医生访谈-在大型学术医疗中心由来自OR，ICU和远程医疗团队的84名参与者进行了研究。我们使用患者安全系统工程计划（SEIPS）框架，在归纳和演绎编码的支持下进行了主题分析。

结果

手术后的交接可分为四个阶段：转移前准备，转移和设置，报告准备和交付以及转移后护理。我们在OR-ICU工作系统中发现了标准化交接协议和相关风险因素的合规性失败，包括团队协作有限，缺少交接专用工具以及临床医生不愿接受的情况。为了改善移交，临床医生为开发协作式电子健康记录（EHR）集成的移交工具和重新设计移交过程提供了建议。

结论

遵从性故障在所有移交阶段中都很普遍，导致对标准化的依从性差。我们提出用于设计“灵活标准化”捆绑式交接干预措施的理论基础指南，以确保从OR到ICU护理过渡的护理连续性。