193 - A Standardized Perioperative Handoff Between the NICU and OR

Sunday, April 30, 2023

3:30 PM – 6:00 PM ET

Poster Number: 193
Publication Number: 193.332

Joanna N. Jain, Boston Children's Hospital, San Jose, CA, United States; Dara Brodsky, Harvard Medical School, Beth Israel Deaconess Medical Center, Newton, MA, United States; Cathie T. Jones, Boston Children's Hospital, Boston, MA, United States; Carolyn G. Butler, Boston Children's Hospital, Boston, MA, United States; Emily Whitesel, Boston Children's Hospital, Boston, MA, United States

Presenting Author(s)

Joanna N. Jain (she/her/hers)

Student Researcher
Boston Children's Hospital
San Jose, California, United States

Background: NICU infants requiring surgery need a well-coordinated handoff between neonatologists and anesthesiologists to ensure appropriate communication and promote patient safety in this vulnerable population. These cross-discipline handoffs carry a high risk for communication errors, which can result in adverse outcomes. Despite this, research on effective perioperative handoffs in the NICU has been limited.

Objective: We aimed to implement and evaluate a standardized handoff approach between neonatologists and anesthesiologists caring for infants transferring between the NICU at Beth Israel Deaconess Medical Center (BIDMC) and the OR at Boston Children’s Hospital (BCH). These institutions are located across the street from each other and have separate charting systems. Thus, face-to-face handoffs are not feasible, necessitating an alternate structured handoff system.

Design/Methods: In 11/2020, we standardized perioperative handoffs using an email template for BIDMC neonatologists with suggested relevant clinical information, family contact information, and preferred language. We also created a process for BIDMC neonatologists to identify the BCH anesthesiologist assigned to the case. Content suggestions for post-operative verbal report by anesthesiologists were included. We then surveyed providers about this new process. In addition, we conducted a chart review of patients transferred between the BIDMC NICU and BCH OR in the 24 months preceding and 18 months following implementation of the new process.

Results:

Between 12/2018 and 6/2022, 65 infants were transferred between the BIDMC NICU and BCH OR. 43 transfers occurred before implementing the handoff process, and 22 occurred after. Of the 65 cases, 57 (88%) were non-urgent, with inguinal hernia repairs being most common (77%). The mean birth gestational age was 29.5 weeks and mean postmenstrual age at transfer was 38.4 weeks.

19 BIDMC neonatologists and 21 BCH anesthesiologists responded to the survey. With the handoff tool, the frequency of sign-out between services increased, and providers reported that sign-out was useful to OR management (Figure). Providers reported that the handoff tool improved communication and patient safety, facilitating a positive relationship between disciplines (Table 1). Barriers to initiating handoff were largely resolved (Table 2).

Conclusion(s): Implementing the perioperative handoff was well-received by both disciplines. Standardized cross-discipline handoffs are feasible, allow for reliable transfer of information, are perceived to improve neonate safety, and increase provider satisfaction.