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A Non-Traditional Texas "Two"-Step: Using "Handoffs" and "Huddles" to Enhance a Culture of Patient Safety in the Obstetric Suite
Abstract Number: S 5
Abstract Type: Original Research
Effective communication is key to enhancing a culture of patient safety in any clinical setting-especially the dynamic obstetric suite. Poor communication has been cited as a common root cause of sentinel events. Regulatory bodies such as CMS, Joint Commission, and ACGME promote effective communication among healthcare providers. In this era where major changes in health care delivery are anticipated, it is paramount that anesthesiologists endorse improved communication, teambuilding, and patient safety. Recently, obstetric anesthesia checkout rounds at the authors' institution were restructured to include tools from TeamSTEPPS, an evidence-based program developed by Agency for Healthcare Research & Quality to enhance provider performance and patient safety. This ongoing IRB-approved "two"-fold QI study has aimed to implement modifications of TeamSTEPPS tools -handoffs mnemonic "I PASS the BATON" and multidisciplinary "huddles" -for use in obstetric anesthesia and to evaluate these practices.
1. Prior to implementation, clinicians from multiple disciplines attended a conference introducing them to tools to be used. A 5-point teamwork pretest was administered; a posttest was given 6 months later.
2. To evaluate obstetric anesthesia handoffs practices, 47 handoffs have been observed thus far where trainees were randomized to use either a non-standardized method or the standardized handoff tool. Patient information transfer scores (PITS) were calculated and represent the percentage of information (from a checklist) transferred between trainees.
An independent, two-sample t-test assuming unequal variances compared PITS between handoffs groups. PITS were significantly greater (p<0.001) among trainees who used the standardized tool (mean=92.6, sd=7.6) compared to those who did not (mean=69.5, sd=20.4). On average, trainees using the tool scored 23.1 points higher (95% CL: 14,32) than those who did not.
The teamwork pretest mean score was 3.82 (sd=0.42); posttest data is not yet available.
This "two"-step demonstrates an efficacious use of standardized handoffs and huddles in obstetric anesthesia where communication has improved intra- and interdepartmentally. As the high-risk parturient population increases, good communication through the continuum of care will remain of critical importance to achieving optimal maternal/fetal outcomes.
Segal N. A42 ASA Annual Mtng 2012
Nagpal K. Annals of Surg 2011