Measure ID

Percentage of patients with documentation of transfer of care handoff in ICU.

Measure Type
Available for Provider Feedback

Lack of communication or miscommunication between anesthesia providers and perioperative nurses can lead to patient harm. Anesthesia providers routinely transfer patients from the operating room (OR) to the ICU, and 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.1-2

The Agency for Healthcare Research and Quality found that “current signout mechanisms are generally ad-hoc, varying from hospital to hospital and unit to unit.” (Link to Patient Safety Network - Handoffs and Signouts Article [accessed June 30, 2015]). According to data published by the Joint Commission, communication errors were indicated in 59% of reported sentinel events in 2012 and in 54% of operative/post-operative complications between 2004 and 2012. A 2006 survey among residents at Massachusetts General Hospital found that 59% of respondents reported one or more patients experiencing harm as a result of ineffective patient handoff practices during their most recent clinical rotation.

Therefore, a standardized transfer of care protocol or handoff tool/checklist that is utilized for all patients directly admitted to the ICU after undergoing a procedure under the care of an anesthesia practitioner will facilitate effective communications between the medical practitioner who provided anesthesia during the procedure and the care practitioner in the ICU who is responsible for post-procedural care. This should minimize errors and oversights in medical care of ICU patients after procedures.

Measure Time Period

All patients requiring anesthesia and are transferred to the ICU following the procedure.

  • ASA 5 & 6 including Organ Procurement (CPT: 01990)
  • Patients not transferred directly to a ICU (determined by the Postoperative Destination value code: 0)
  • Procedures:
    • Anesthesia for diagnostic or therapeutic nerve blocks/injections (CPT: 01991, 01992)
    • Labor Epidurals (determined by the Obstetric Anesthesia Type value codes: 3 & 6 including Obstetric non-operative procedures - CPT: 01958)
Success Criteria

Documentation of ICU handoff/transfer of care in the electronic anesthesia record including the key handoff elements used.

Other Measure Details

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 ICU events.

Note: Only cases determined to be transferred to ICU by the phenotype will be included for this measure.

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

  1. Identification of patient, key family member(s) or patient surrogate
  2. Identification of responsible practitioner (primary service)
  3. Discussion of pertinent/attainable medical history
  4. Discussion of surgical/procedure course (procedure, reason for surgery, procedure performed)
  5. Intraoperative anesthetic management and issue/concerns to include things such as airway, hemodynamic narcotic, sedation level and paralytic management and intravenous fluids/blood products and urine output during the procedure
  6. Expectations/Plans for the early post-procedure period to include things such as the anticipated course (anticipatory guidance), complications, need for laboratory or ECG and medication administration
  7. Opportunity for questions and acknowledgement of understanding of report from the receiving ICU 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.

*This measure will include valid MPOG cases defined by the Is Valid Case phenotype.

Risk Adjustment

Not applicable

Provider Attribution

Provider(s) signed in at Anesthesia End.

MPOG Concept Used
  • 50623   Handoff MPOG Concept IDs
  • 50066   Phase I Recovery Room In Date/Time
  • 50623   Compliance- PACU/ICU Handoff of care performed, report given.
  • 50067   Phase I Recovery Room Out Date/Time
  • 50068   Phase II Recovery Room In Date/Time
  • 50069   Phase II Recovery Room Out Date/Time
  • 50070   Phase III Recovery Room In Date/Time
  • 50071   Phase III Recovery Room Out Date/Time
  • 50008   AACD Patient Out of Room Date/Time
  • 50010   AACD Recovery Room In Date/Time
  • 50706   Categorized Note – Postoperative Recovery
  • 50734   Emergence – Patient Recovery Location
MPOG Phenotypes Used
  1. Dusse, F., Pütz, J., Böhmer, A. et al. Completeness of the operating room to intensive care unit handover: a matter of time?. BMC Anesthesiol 21, 38 (2021).
  2. Methangkool E, Tollinche L, Sparling J, Agarwala AV. Communication: Is There a Standard Handover Technique to Transfer Patient Care? Int Anesthesiol Clin. 2019 Summer;57(3):35-47. doi: 10.1097/AIA.0000000000000241. PMID: 31577236; PMCID: PMC6777853
  3. 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; 14:401–7
  4. Segall N, Bonifacio AS, Schroeder RA, Barbeito A, Rogers D, Thornlow DK, Emery J, Kellum S, Wright MC, Mark JB, Durham, V. A. Patient Safety Center of Inquiry: Can we make postoperative patient handovers safer? A systematic review of the literature. Anesth Analg 2012; 115:102–15
Measure Authors

 Measure Author


 Nirav Shah, MD

 University of Michigan

 Kate Buehler, MS, RN

 University of Michigan

 Genevieve Bell

 University of Michigan

 Sachin Kheterpal, MD

 University of Michigan

 MPOG Quality Committee



Measure Reviewer(s)
Next Review: 2026
 Date Reviewed  Reviewer  Institution  Summary  QC Vote


 Alvin Stewart, MD



 Continue as Is

Published Date: 05/2017
 Date  Criteria  Revision