Intraoperative Anesthesia Care Transition Checklist
| Status: | Active, not recruiting |
|---|---|
| Conditions: | Hospital |
| Therapuetic Areas: | Other |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 4/17/2018 |
| Start Date: | June 2015 |
| End Date: | March 2020 |
The Effects of Implementing an Anesthesia Information Management System Guided Intraoperative Anesthesia Care Transition Checklist on Postoperative Complications: A Randomized Trial
Perioperative management decisions must often be made quickly and rely on practitioners
having relevant facts at hand. During transitions of patient care between anesthesia
providers, known as "handovers," information may not be completely or faithfully
communicated, consequently impairing the provider's ability to intervene correctly in
response to subsequent events. Checklists have consistently proven to be effective at
enhancing communications during handovers, but whether anesthesia checklists improve patient
outcomes has yet to be proven. The investigators propose to randomize intraoperative
anesthesia provider handovers to standard practice (no specific format) or to a handover
checklist presented by a decision-support system in conjunction with the investigators
electronic record. Specifically, the investigators will test the hypothesis that
incorporating a largely pre-populated handover checklist into transitions of intraoperative
anesthesia care decreases a composite of mortality and serious cardiovascular, respiratory,
gastrointestinal, urinary, and infectious complications.
having relevant facts at hand. During transitions of patient care between anesthesia
providers, known as "handovers," information may not be completely or faithfully
communicated, consequently impairing the provider's ability to intervene correctly in
response to subsequent events. Checklists have consistently proven to be effective at
enhancing communications during handovers, but whether anesthesia checklists improve patient
outcomes has yet to be proven. The investigators propose to randomize intraoperative
anesthesia provider handovers to standard practice (no specific format) or to a handover
checklist presented by a decision-support system in conjunction with the investigators
electronic record. Specifically, the investigators will test the hypothesis that
incorporating a largely pre-populated handover checklist into transitions of intraoperative
anesthesia care decreases a composite of mortality and serious cardiovascular, respiratory,
gastrointestinal, urinary, and infectious complications.
The modern team-based approached to patient care often involves transitioning care between
providers. Critical details may be lost during transition, or handovers, resulting in delays,
inefficiencies, suboptimal care, or even patient harm. The Joint Commission on Hospital
Accreditation declared that communication failures are the root cause of almost two-thirds of
all sentinel events. The World Health Organization similarly listed "communication during
patient care handover" as one of the highest patient safety initiatives. The consequence of
ineffectual communication may be especially detrimental during surgery when patients are
often unstable and post-handover decisions must be made quickly and accurately. In a
preliminary study the investigators observed an 8% increase in odds of experiencing major
in-hospital morbidity or mortality per for each intraoperative handover.
Checklists have been used for transitions of care in a variety of areas; orthopedic trauma,
urological robotic surgeries, and emergency departments. The field of anesthesia has also
embraced the use of checklists, especially in the handover to intensive care units.
Post-anesthesia checklists have been the particular focus of anesthesia providers in recent
years. Post-operative checklists clearly enhance information transfer, but have only been
evaluated using historical controls which do not account for bias. The anesthesia area most
lacking valid studies is intraoperative handovers.
Anesthesia-specific intraoperative handovers differ because the interaction is primarily
between anesthesia providers while surgery continues without disruption. To date, there has
only been one proposed checklist for intraoperative handovers between anesthesia providers
and it has not been prospectively evaluated. A randomized study with contemporaneous
controls, utilizing an anesthesia specific, electronically pre-populated checklist measuring
objective "hard" outcomes will address the limitations of previous studies.
The investigators propose to test the hypothesis that incorporating an electronic handover
checklist during transitions of intraoperative anesthesia care reduces serious complications.
Specifically, the investigators will quantify the effect of a handover checklist on adverse
outcomes as defined by a composite of mortality and serious cardiovascular, respiratory,
gastrointestinal, urinary, and infectious complications.
providers. Critical details may be lost during transition, or handovers, resulting in delays,
inefficiencies, suboptimal care, or even patient harm. The Joint Commission on Hospital
Accreditation declared that communication failures are the root cause of almost two-thirds of
all sentinel events. The World Health Organization similarly listed "communication during
patient care handover" as one of the highest patient safety initiatives. The consequence of
ineffectual communication may be especially detrimental during surgery when patients are
often unstable and post-handover decisions must be made quickly and accurately. In a
preliminary study the investigators observed an 8% increase in odds of experiencing major
in-hospital morbidity or mortality per for each intraoperative handover.
Checklists have been used for transitions of care in a variety of areas; orthopedic trauma,
urological robotic surgeries, and emergency departments. The field of anesthesia has also
embraced the use of checklists, especially in the handover to intensive care units.
Post-anesthesia checklists have been the particular focus of anesthesia providers in recent
years. Post-operative checklists clearly enhance information transfer, but have only been
evaluated using historical controls which do not account for bias. The anesthesia area most
lacking valid studies is intraoperative handovers.
Anesthesia-specific intraoperative handovers differ because the interaction is primarily
between anesthesia providers while surgery continues without disruption. To date, there has
only been one proposed checklist for intraoperative handovers between anesthesia providers
and it has not been prospectively evaluated. A randomized study with contemporaneous
controls, utilizing an anesthesia specific, electronically pre-populated checklist measuring
objective "hard" outcomes will address the limitations of previous studies.
The investigators propose to test the hypothesis that incorporating an electronic handover
checklist during transitions of intraoperative anesthesia care reduces serious complications.
Specifically, the investigators will quantify the effect of a handover checklist on adverse
outcomes as defined by a composite of mortality and serious cardiovascular, respiratory,
gastrointestinal, urinary, and infectious complications.
Inclusion Criteria:
- non-cardiac surgery
Exclusion Criteria:
- under 18 years of age
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