A surgery center focused a QI project on communication between OR anesthesia staff and post-anesthesia care unit (PACU) staff after observing issues related to hand-off communication.
“We did research on different methods and came up with four different types of hand-offs that you could use to improve the communication between getting the patient off from one area to the next,” says Sharon Petruzzi, RN, nurse manager, Susquehanna Surgery Center in Bloomsburg, PA. “We did some education, discussions, and brainstorming with the staff, and we did some trials and found that SBAR fit our organization well,” she adds.
SBAR is a communication method that stands for situation, background, assessment, and recommendation. Originally, SBAR was developed by the U.S. Navy as a way to communicate information on nuclear submarines, but the healthcare industry adopted it about 20 years ago. (Learn more about the tool at: http://bit.ly/2MIOutU.)
Project leaders at Susquehanna Surgery Center wanted communication during hand-off to be accurate, clear, specific, and to provide an opportunity for asking questions and voicing concerns. Using SBAR, the surgery center provided staff with a concise, predictable way of giving reports, using remeasurements.
The project’s performance goal was to have 97% of patients transferred from the OR to PACU to have a standardized report during the hand-off from OR to PACU staff. The goal acknowledged the reality of how a new or flex nurse might be working in the OR occasionally, and they might not remember the hand-off goals.
“We focused mainly on orthopedics because we have a large population of orthopedics. That population has more complex issues than some other populations,” Petruzzi says. “Also, we knew that the change would be adopted by other specialties as well.”
The change included staff education and displaying a laminated description of each element of SBAR. It resulted in a big improvement that has continued since 2017. “After the first measurement, when we didn’t reach our goal, we sat down with staff and discussed reasons why we didn’t get to where we wanted to be with the goal,” Petruzzi reports. “We did re-education, and they said that sometimes we forget the way things should go.”
The laminated signs were created as a reminder. The surgery center used a preoperative phone call checklist to ensure all essential information was collected.
The one-page checklist includes questions such as “Does your primary care provider know you are undergoing this procedure?” and “Did you undergo any abnormal medical tests in the past 12 months?” Also, the list includes results of preop lab work, ECG, and medical clearance; current medications; preop instruction for patients (e.g., what to eat and drink, reminders to bring crutches or contact lenses); and expectations regarding wait times.
Staff discussions helped create buy-in among surgery center employees. It also was the best way to identify solutions because the surgery center’s nurses are experienced and bring a lot to the table, Petruzzi notes. “They are very interested in quality care for all of our patients. I didn’t have a hard time with buy-in.”
The staff meetings and brainstorming sessions were helpful and facilitated the quality improvement process. “I asked staff, ‘What do you think are the barriers to a good hand-off?’” Petruzzi reports. “Some said, ‘Distraction, noise, trying to get ready for the next patient, and things like that.’”
The more managers involve employees in the QI process, the more likely they will be to embrace changes and the easier it will be to make improvements. It is less stressful for staff to make system and process changes if they are part of the solution and are not feeling as though changes are dictated from management without their input.
The QI project has resulted in long-term gain, too. “They seem to be following through with the new communication process,” Petruzzi says. “They got into the new habit for a good period.”
It is less stressful for staff to make system and process changes if they are part of the solution and are not feeling as though changes are dictated from management without their input.
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