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

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.

Anesthesia Start to Anesthesia End.

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)

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

Not applicable

Provider(s) signed in at Anesthesia End.

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). https://doi.org/10.1186/s12871-021-01247-3
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