Pre-op hand-off improvements begin Sept. 16

New standardized tool closes communication gaps

Hand-offs among surgeons, nurses and anesthesiologists in the preoperative area are a crucial time to communicate information needed to keep patients safe. This update is especially for surgical and anesthesia colleagues.

I have been working with nursing leadership to improve this process and wanted to make you aware of changes we will roll out on Monday, Sept. 16.

In recent months, errors in the hand-off process have resulted in some patients arriving in the operating room missing critical pieces of the preoperative checklist. Examples include:

• A patient anesthetized before the surgeon could address surgical decision-making with the patient
• Surgeons not being in-house and/or available
• A change in covering surgeon
• Missing site marking
• Missed medication administration
• Critical lab studies not performed

Our investigation of PSAs from these cases revealed that lapses in communication among nurses, anesthesiologists and surgeons were a common problem. Other factors included pressure to maintain an efficient workflow and changing requirements and tools, leading to different providers following different standards.

Our goal is to get all stakeholders to use an improved, standardized tool so it is clear when a patient is ready to be transported to the OR.

The recommendation from our 4SPS group was to adapt an older paper hand-off form. The revised form has a list of critical checks that must be completed before an anesthesiologist brings the patient to the OR, as well as the name and number of the preoperative nurse in case of concerns.

These forms will be placed on every patient's bedside table in prep. The prep nurse will cross off items they complete. Surgeons are expected to cross out the lines confirming their availability and site marking (if applicable) when seeing each patient in prep. If you plan to leave the building or are no longer available, we ask that you notify the charge nurse, who will note this on the form. The anesthesiologists will double-check that all items have been completed prior to transporting every patient to the OR.

We will try to be efficient; if an item is clearly not checked by oversight we will check it for you and remind you afterwards, but our goal is to have all parties take ownership in this important process. 

The new form has been vetted and improved during two tests of change with small groups of surgeons. We feel the system has worked well and is now ready to roll out universally. We need everyone to incorporate this standardized process into their workflow to ensure that the steps most critical to patient safety will be reliably completed. 

You are welcome to reach out to me personally or to Angie Anderson or Eric Shields with questions or concerns about this new process. Thank you for helping make Salem Hospital a safer place to have surgery.