Quality Improvement Initiative Increased Patient Safety and Reduced Adverse Effects During Handovers in Anesthesia Care

December 6, 2023

Handovers, which involve the transferring of a patient’s care from one health care provider to another, are unavoidable. Handovers typically occur to prevent provider fatigue, excessive work hours or to introduce a fresh perspective to a complex case. Unfortunately, there is evidence to suggest that important information can be lost during these transitions with a negative impact on patients.

To help improve these transfers, many health systems have implemented structured handover tools through quality improvement initiatives.

Now, a recent study from researchers at Wake Forest University School of Medicine shows that the implementation of a structured handover tool in anesthesia care may lead to a reduction in hand-off-related adverse events.

The findings appear online in Anesthesiology.

“This is the first known data to show that structured handovers, which have previously been shown to improve information transfer and clinician satisfaction, also improve patient outcomes,” said Scott Segal, M.D., professor of anesthesiology at Wake Forest University School of Medicine and corresponding author of the study.

The retrospective study included more than 120,000 cases at Atrium Health Wake Forest Baptist Medical Center from 2016 to 2021 of adult patients undergoing non-cardiac surgery that lasted at least one hour. Handovers were defined as a change of attending anesthesiologist, nurse anesthetist or resident for more than 35 minutes. The research team found that 40.4% of the cases included handovers.

“Our data confirmed the association of handovers and negative impact on patient outcomes,” Segal said. 

However, in 2019, the Medical Center implemented a quality improvement initiative that encouraged the use of a structured handover tool incorporated into electronic health records. 

The tool includes a detailed case summary that outlines preoperative notes and medications, estimated blood loss, anesthesia events and times, provider concerns, postoperative management plans, and more.

“After the implementation of our quality improvement initiative, there was a significant increase in the adoption of this tool from about 30% to 90%, which was accompanied by a parallel decrease in the risk of handover-related adverse patient outcomes,” Segal said. “When we looked at our data, there was an unmistakable pattern showing improved outcomes as uptake of the tool increased.”

Segal also said that a prospective randomized trial is needed to further evaluate the effect of handovers on patient outcomes.

Media Contact: Myra Wright, mgwright@wakehealth.edu