QI Project 2016 Anesthesia to ICU / ICU to Anesthesia Hand offs

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Presentation transcript:

QI Project 2016 Anesthesia to ICU / ICU to Anesthesia Hand offs Zach Hesse, Kristina Coger, Brian dugger Rachel Kacmar, Phil Pian?

Scenario Critically ill patient comes directly from ED to OR for spine decompression Arrives to OR from elevator Complicated medical hx Difficult airway Long procedure - ends at 20:00 Transfer to neuro ICU What issues can you anticipate regarding hand-offs with this patient?

effective hand-offs Efficient transfer of pertinent pt information quickly summarize illness severity, patient summary, actions regarding patient, contingency planning Standardization reduces error We see lots of hand-offs in anesthesia

Obstacles to Hand-offs Time crunch Lack of available staff Old notes / poor records Long complicated procedures Whisper down the line effect

SMART AIM To create a more standardized ICU to OR and OR to ICU hand-off process to prevent the loss of vital patient information Happening with OR to ICU transfers in SICU What about ICU to OR transfers? What about all of those other ICUs We propose initiating a comprehensive OR/ICU handoff process where all ICUs can expect the same standard of care Goal of reducing preoperative events and improving communication

Implementation Laminated cards in each OR with pertinent phone numbers Pre-operatively touch base with resident / ACP to touch on on-going issues / medical hx / goals for OR Nursing assessment to discuss lines / fluids / hemodynamics / antibiotics / transfer timing

Implementati0n Post-operative Quick call to ICU provider: Heads up with a quick and dirty overview Upon arrival: nursing, anesthesia, surgical and ICU teams are present Pt hooked up to monitors, stable vitals ensured - no hand off until vitals are stable Nursing team provides standard hand-off sheet to anesthesia, nursing and surgical teams All parties present and attentive for hand-off and available for questions We would propose implementing this for approximately 6 months in the burn / neuro ICU to determine if care / provider satisfaction improves

Example: PREOP PMH & PSH Allergies Meds - specify which taken prior to surgery, especially beta-blockers, sedatives, abs Baseline vitals signs, height weight Baseline physical exam - neurologic, demeanor, etc Baseline labs INTRAOP: Airway - intubation technique, abnormalities, etc Lines - size, location, etc.. Procedures - blocks, spinals, etc… Fluid totals Paralytic status - relaxed, reversed Labs Meds - narcotic totals, antibiotics, anticoagulants, anticonvulsants, etc… Key events - i.e unexpected episode of SVT / hypotension / hypoxia CONCLUSION “the thing that I am most concerned about this patient is….”