Department of Cardiothoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.
Department of Anesthesiology and Critical Care, University of Texas Southwestern Medical Center, Dallas, Texas.
Ann Thorac Surg. 2020 Jun;109(6):1782-1788. doi: 10.1016/j.athoracsur.2019.09.047. Epub 2019 Nov 9.
The ability of handoff redesign to improve short-term outcomes is well established, yet an effective approach for achieving widespread adoption is unknown. An implementation science-based approach capable of influencing the leading indicators of widespread adoption was used to redesign handoffs from the cardiac operating room to the intensive care unit.
A transdisciplinary, unit-based team used a 12-step implementation process. The steps were divided into 4 phases: planning, engaging, executing, and evaluating. Based on unit-determined best practices, a "handoff bundle" was designed. This included team training, structured education with video illustration, and cognitive aids. Fidelity and acceptability were measured before, during, and after the handoff bundle was deployed.
Redesign and implementation of the handoff process occurred over 12 months. Multiple rapid-cycle process improvements led to reductions in the handoff duration from 12.6 minutes to 10.7 minutes (P < .014). Fidelity to unit-determined handoff best practices was assessed based on a sample of the cardiac surgery population preimplantation and postimplementation. Twenty-three handoff best practices (information and tasks) demonstrated improvements compared with the preimplementation period. Provider satisfaction scores 2.5 years after implementation remained high compared with the redesign phase (87 vs. 84; P = .133).
The use of an implementation-based approach for handoff redesign can be effective for improving the leading indicators of successful adoption of a structured handoff process. Future quality improvement studies addressing sustainability and widespread adoption of this approach appear to be warranted, and should include the relationships to improved care coordination and reduced preventable medical errors.
手递手交接的重新设计能够改善短期结果已得到充分证实，但实现广泛采用的有效方法尚不清楚。采用基于实施科学的方法，能够影响广泛采用的主要指标，从而对手递手交接进行重新设计，从心脏手术室到重症监护病房。
跨学科的、基于单元的团队使用了 12 步实施过程。这些步骤分为 4 个阶段：规划、参与、执行和评估。根据单元确定的最佳实践，设计了一个“交接包”。其中包括团队培训、带视频说明的结构化教育和认知辅助工具。在交接包部署之前、期间和之后，都对保真度和可接受性进行了测量。
手递手交接过程的重新设计和实施历时 12 个月。多次快速循环的流程改进使得交接时间从 12.6 分钟缩短到 10.7 分钟（P <.014）。根据实施前和实施后的心脏手术人群样本，对接手最佳实践的保真度进行了评估。与实施前相比，23 项交接最佳实践（信息和任务）得到了改善。实施 2.5 年后，提供者的满意度评分仍高于重新设计阶段（87 比 84；P =.133）。
在手递手交接重新设计中使用基于实施的方法可以有效地改善成功采用结构化交接流程的主要指标。未来的质量改进研究似乎需要解决这种方法的可持续性和广泛采用问题，并且应该包括与改善护理协调和减少可预防的医疗错误的关系。
