311 - Handoff Communication Process to Optimize Patient Safety and Flow from Pre-op to the OR
Description: Description of Team The interdisciplinary team included perioperative RNs, anesthesia professionals, and management. Throughout the process, front-line RNs and anesthesiologists were consulted for their feedback. Preparation and Planning Prior to implementation, there was inconsistent hand-off communication between the two units due to a lack of a standardized process. This could lead to missed diagnostic results, incomplete consents, and a lack of sharing critical information. The interdisciplinary team came together to brainstorm solutions to the identified issues: continuum of care, patient safety, and efficiency of flow. Assessment The preop nurse utilized a checklist during the initial assessment of a patient prior to surgery. The checklist was left for the OR nurse and anesthesiologist to review. There was a lack of accountability if the OR nurse arrived to the Preop unit, and there were components that had not been completed. This led to a disconnect between the preop nurse and the OR team because once the nurse had completed the preop process, there was no verbal handoff. Implementation It was determined that a verbal handoff was essential to improving the quality of conveyed information to minimize communication breakdown. The verbal report is driven by a standardized checklist, resulting in the creation of the Ticket to Ride (TTR). This is based on the AORN Guideline for Team Communication, Recommendation II. The TTR is a checklist that includes the verification of patient identity, site markings, signed consents, and an updated H&P. The preop nurse, OR nurse, and anesthesiologist engage in a bedside handoff report utilizing the TTR prior to the transfer to the OR. Team education was provided prior to implementation, and TTR Champions were available for coaching during the roll-out. Outcome The TTR allows for all parties to be present to discuss and verify the necessary components prior to the patient transfer. Upon implementation, the OR nurse and anesthesiologist set an agreed time to meet at the patient bedside, and they arranged their room set-up schedule around that time. The preop nurses made themselves available to meet with the OR team, as well. This was challenging during the initial implementation as routines had to change; however, all parties found it positive and have been successful. An unexpected benefit of the TTR was that the preop nurse and OR nurse have a new-found comradery. Prior to the TTR, preop and OR were two separate units where the staff rarely collaborated. Currently, we are seeing work relationships grow and the two units working in partnership. Implications for Perioperative Nursing Perioperative nursing is responsible for a thorough assessment of the patient, as well as verification of diagnostic results and documentation, all within a short amount of time. The TTR allows for the team to pause the process and focus on the patient to validate all components are complete.