Michelle Meneses, DNP, MS, AGPCNP-BC , Department of Nursing, NYU Langone Orthopedic Hospital, New York, NY; and NYU Rory Meyers College of Nursing, NYU Langone Health, New York, NY.
Nishanth Muthusamy, BA , Department of Orthopedic Surgery, NYU Langone Health, New York, NY.
Orthop Nurs. 2022;41(4):282-286. doi: 10.1097/NOR.0000000000000863.
Patients undergoing total joint arthroplasty (TJA) with multiple comorbidities require medical clearance recommendations from their primary care provider, which if not adhered to can lead to adverse postoperative complications. In this quality improvement initiative, we explore the impact of a standardized handoff process incorporating medical clearance postoperative recommendations and orthopaedic-specific context on information transfer in TJA. A systematic review of quantitative and qualitative studies from 2014 to 2019 was completed to draw a conclusion about the best practice methods for the development of a standardized handoff process. Prior to implementation, evidence was reviewed to inform activities such as baseline chart audits, attainment of stakeholder input regarding handoff, exploration of wound closure equipment utilization, and standardization of a structured "smart phase" that incorporates medical clearance recommendations and orthopaedic-specific context information. After provider education was completed and the new handoff approach initiated, data were collected to compare postintervention outcomes such as transfer of information and wound kit distribution cost analysis. At baseline, 42% of patients had medical clearance postoperative recommendations handed off when they were provided. At completion, the new handoff smart phrase was used 97% for the first handoff and 100% for the second handoff. Medical clearance postoperative recommendations were captured in the electronic health record 83% of the time when they were provided. When the new smart phrases were utilized, wound closure, precautions, and postoperative void status were always handed off. Once wound closure technique was specified, bedside nurses were able to provide the appropriate wound closure removal equipment at discharge, projecting cost savings of $0.69 per case (∼234 cases per month). The use of a standardized handoff smart phrase that includes specialty specific context and postoperative medical management requirements successfully improved the information transfer between providers in a large academic orthopaedic medical center.
接受人工关节置换术（TJA）的患者通常合并多种共病，需要其初级保健医生提供医疗许可建议，如果未遵循这些建议，可能会导致术后不良并发症。在这项质量改进计划中，我们研究了标准化交接流程的影响，该流程纳入了术后医疗许可建议和骨科特定背景信息，以改善 TJA 中的信息传递。对 2014 年至 2019 年的定量和定性研究进行了系统回顾，以得出关于制定标准化交接流程的最佳实践方法的结论。在实施之前，审查了证据，以告知基线图表审核、获取有关交接的利益相关者意见、探索伤口闭合设备的使用情况以及标准化包含医疗许可建议和骨科特定背景信息的结构化“智能阶段”等活动。在完成提供者教育并启动新的交接方法后，收集数据以比较干预后的结果，如信息传递和伤口套件分发成本分析。在基线时，有 42%的患者在提供时交接了术后医疗许可建议。完成后，新的交接智能短语在第一次交接时使用了 97%，在第二次交接时使用了 100%。当提供医疗许可术后建议时，电子健康记录中有 83%的时间记录了这些建议。当使用新的智能短语时，伤口闭合、预防措施和术后排空状态总是进行交接。一旦指定了伤口闭合技术，床边护士就可以在出院时提供适当的伤口闭合去除设备，预计每个病例节省 0.69 美元（每月约 234 例）。使用包含专科特定背景和术后医疗管理要求的标准化交接智能短语，成功地改善了大型学术骨科医疗中心中提供者之间的信息传递。
