Percentage of patients, regardless of age, who are under the care of an anesthesia practitioner and are admitted to a PACU in which a post-anesthetic formal transfer of care protocol or checklist which includes the key transfer of care elements is utilized.

Lack of communication or miscommunication between anesthesia providers and perioperative nurses can lead to patient harm.^1,2 The Anesthesia Patient Safety Foundation identified ‘Patient-related communication issues, handoffs, and transitions of care’ as one of the top twelve Perioperative Safety Priorities for the specialty in 2018.⁵ The Joint Commission cited communication error as the number one cause of all anesthesia related sentinel events reported between 2004-2015.  Because anesthesia providers routinely transfer patients from the operating room (OR) to the PACU, they are responsible for communicating important information regarding the patient’s history, intraoperative course, and plans for pain management during the recovery period. Literature suggests that the handover process is more effective in relaying this important information when supported by the use of a standardized checklist. ^3-4

Anesthesia start to Anesthesia End

• All patients, regardless of age, who are cared for by an anesthesia practitioner AND directly transferred from the anesthetizing location to PACU or other non-ICU location after the procedure where a transfer of care occurs.

• Patients not transferred directly to a PACU as determined by the Postoperative Destination phenotype.
• Open Cardiac Cases
• Obstetric Non-operative Procedures (CPT: 01958)
• Labor Epidurals (as determined by the MPOG 'Obstetric Anesthesia Type' Phenotype results 'Labor Epidural' and 'Conversion (Labor Epidural Portion)')
• Daily Hospital Management of Epidural (CPT: 01996)
• Organ Harvest (CPT: 01990)
• Radical clavicle or scapula surgery (CPT: 00452)
• Thoracolumbar sympathectomy (CPT: 00622)
• Lumbar chemonucleolysis (CPT: 00634)
• Diagnostic arteriography/venography (CPT: 01916)
• Burn debridement/grafting for 9% TBSA (CPT: 01953)
• Unlisted Anethesia Procedures (CPT: 01999)
• Cases where the ‘Measure End Time’ precedes ‘Measure Start Time’ will be excluded and marked 'invalid'

A transfer of care protocol or handoff tool/checklist that includes the key handoff elements is used.

The percentage of handoffs will be calculated as number of handoffs documented as “yes” in the electronic anesthesia record where the denominator equals the number of direct transfer to PACU events.

Note: Postoperative destination is determined using the MPOG Postoperative Destination phenotype. Cases identified as transferred to ICU, another postoperative destination (floor, MRI, CT), or as an intraoperative mortality will be excluded from the measure. All other cases will be assumed to be transferred to PACU and therefore included.  

The key handoff elements that must be included in the transfer of care protocol or checklist include:

1. Identification of patient
2. Identification of responsible practitioner (PACU nurse or advanced practitioner)
3. Discussion of pertinent medical history
4. Discussion of surgical/procedure course (procedure, reason for surgery, procedure performed)
5. Intraoperative anesthetic management and issue/concerns
6. Expectations/Plans for the early post-procedure period
7. Opportunity for questions and acknowledgement of understanding of report form the receiving PACU team

Identification of patient- In the instance the identity of the patient is unable to be confirmed, identification provided by the clinical faculty would suffice toward meeting performance of the measure.

MPOG sites interested in auditing the transfer of care process can utilize the PACU Handoff Form available through the MQUARK application. More information regarding the MQUARK audit application is available on the MPOG website: https://mpog.org/apps/

Not applicable

Anesthesia provider in the room providing care at Anesthesia End

Method for determining Responsible Provider:

1. CRNA attributed if both a CRNA and anesthesiologist are signed in. If CRNA not signed in, Attending anesthesiologist will be attributed.
2. Resident if both a resident and attending anesthesiologist are signed in. If Resident not signed in, Attending anesthesiologist will be attributed.

1. Arora V, Johnson J, Lovinger D, Humphrey HJ, Meltzer DO. Communication failures in patient sign-out and suggestions for improvement: a critical incident analysis. Qual Saf Health Care. 2005;14(6):401-407.
2. Segall N, Bonifacio AS, Schroeder RA, et al. Can we make postoperative patient handovers safer? A systematic review of the literature. Anesthesia and analgesia. 2012;115(1):102-115.
3. Weinger MB, Slagle JM, Kuntz AH, et al. A Multimodal Intervention Improves Postanesthesia Care Unit Handovers. Anesthesia and analgesia. 2015;121(4):957-971.
4. Petrovic MA, Martinez EA, Aboumatar H. Implementing a perioperative handoff tool to improve postprocedural patient transfers. Jt Comm J Qual Patient Saf. 2012;38(3):135-142.
5. Lane-Fall M. APSF highlights 12 perioperative patient safety priorities. APSF Newsletter. 2018; 33(2):33-68.