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Transfer of Anesthesia Care: Optimal Characteristics of a Paper vs. Electronic Hand-off Tool on the Labor and Delivery Unit
Abstract Number: S-62
Abstract Type: Original Research
Communication failures are consistently cited as the leading root cause of sentinel events. The care of an obstetric patient may be transferred among several anesthesia care teams. Information may be lost or miscommunicated during these hand-offs. The purpose of this qualitative study was to explore optimal obstetric anesthesia hand-off characteristics and to compare the perceptions of effectiveness of a paper compared with an electronic hand-off template using face-to-face interviews with anesthesia team members.
At our institution approximately 25 patients are handed off twice daily to an incoming anesthesia team. Historically, a paper template was used to organize hand-off information. In November 2012, a web-based spreadsheet template was trialed for three months.
An interview guide was developed to explore optimal hand-off characteristics, to compare the paper and electronic hand-off templates, and probe for possible improvements in the electronic template. Face-to-face interviews were conducted with resident, fellow, and attending anesthesiologists until thematic saturation was reached. Interviews were transcribed verbatim. Codes were developed using content analysis with an inductive approach, and were altered through consensus to ensure validity. Inter-rater reliability between two coders was 93%.
Ten residents, 4 obstetric anesthesia fellows, and 9 attending anesthesiologists were interviewed. Information desired during hand-offs included an accurate medical and obstetric history, anesthesia-specific findings (e.g. Mallampati class) and information that would cause a deviation from the usual plan of care. Poor quality hand-offs left out pertinent information, spent too much time on irrelevant information and did not highlight critical information.
Comparing the paper and electronic hand-off systems, providers felt that the electronic template was not as easily accessible, was not as efficient, and was not as customizable as a paper system. However, the electronic template improved legibility and reduced the number of data omissions. While 66% of providers preferred the paper template, many stated that they would prefer an electronic one if it could auto-populate data from the electronic medical record and if it were accessible from a mobile device.
Our interviews delineate important characteristics of an obstetric anesthesia hand-off and suggest that an electronic template could improve the completeness and legibility of patient hand-offs, thereby improving patient safety. However, many improvements to the tool are necessary before it is widely accepted. Future work should directly compare the effectiveness of these two sign-out methods.
Funding: Robert Wood Johnson Foundation award 69779