Errors in communication are a major source of preventable medical errors. Neurosurgical patients frequently present to the neuro-intensive care unit (NICU) postoperatively, where handoffs occur to coordinate care within a large multidisciplinary team. A multidisciplinary working group at our institution started an initiative to improve postoperative neurosurgical handoffs using validated quality improvement methodology. Baseline handoff practices were evaluated through staff surveys and serial observations. A formalized handoff protocol was implemented using the evidence based IPASS format (Illness severity, Patient summary, Action list, Situational awareness and contingency planning, Synthesis by receiver). Cycles of objective observations and surveys were employed to track practice improvements and guide iterative process changes over one year.

Surveys demonstrated improved perceptions of handoffs as organized (17.1% vs 69.7%, p < 0.001), efficient (27.0% vs. 72.7%, p < 0.001), comprehensive (17.1% vs. 66.7%, p < 0.001), and safe (18.0% vs. 66.7%, p < 0.001), noting improved teamwork (31.5% vs. 69.7%, p < 0.001). Direct observations demonstrated improved communication of airway concerns (47.1% observed vs. 92.3% observed, p < 0.001), hemodynamic concerns (70.6% vs. 97.1%, p = 0.001), intraoperative events (52.9% vs. 100%, p < 0.001), neurological examination (76.5% vs. 100%, p < 0.001), vital sign goals (70.6% vs. 100%, p < 0.001), and required postoperative studies (76.5% vs. 100%, p < 0.001). Receiving teams demonstrating improved rates of summarization (47.1% vs. 94.2%, p = 0.005) and asking questions (76.5% vs 98.1%, p = 0.004). The mean handoff time during long-term follow-up was 4.4 min (95% confidence interval = 3.9–5.0 min).

Standardization of handoff practices yields improvements in communication practices for postoperative neurosurgical patients.

沟通错误是可预防医疗错误的主要来源。神经外科患者术后经常出现在神经重症监护病房 (NICU)，在那里进行交接以协调大型多学科团队的护理。我们机构的一个多学科工作组启动了一项计划，以使用经过验证的质量改进方法来改进术后神经外科手术的交接。通过员工调查和连续观察评估了基线交接实践。形式化切换协议是使用基于IPASS格式（证据来实现我llness严重性，P心急总之，一个ction名单，ş ituational意识和应急计划，小号由接收器合成）。客观观察和调查的循环被用来跟踪实践改进并指导一年多的迭代过程变化。

调查表明，对有组织（17.1% 对 69.7%，p < 0.001）、高效（27.0% 对 72.7%，p < 0.001）、全面（17.1% 对 66.7%，p < 0.001）和安全的交接的看法有所改善（18.0% 对 66.7%，p < 0.001），注意到团队合作得到改善（31.5% 对 69.7%，p < 0.001）。直接观察表明改善了气道问题的交流（观察到的 47.1% 对 92.3%，p < 0.001）、血流动力学问题（70.6% 对 97.1%，p = 0.001）、术中事件（52.9% 对 100%，p < 0.001)、神经系统检查（76.5% 对 100%，p < 0.001）、生命体征目标（70.6% 对 100%，p < 0.001）和需要的术后研究（76.5% 对 100%，p < 0.001） . 接收团队展示了改进的总结率（47.1% 对 94.2%，p = 0.005）和提出问题（76.5% 对 98.1%，p = 0.004）。

交接实践的标准化改进了术后神经外科患者的沟通实践。