321 - The Post-Operative Handoff: A Multisite Survey of the Perceptions and Preferences of Pediatric Hospitalists and Surgeons

Poster Number: 321
Publication Number: 321.322

Stephen Overcash, Children's Hospital Los Angeles, Los Angeles, CA, United States; Joyce Koh, Children's Hospital Los Angeles, Manhattan Beach, CA, United States; Christopher Gayer, Children's Hospital Los Angeles, Los Angeles, CA, United States; Mark H. Corden, Children's Hospital Los Angeles, Los Angeles, CA, United States

Background: Post-operative communication errors contribute to patient harm and excess costs. There is limited literature and no existing standards for verbal post-operative handoff to the acute care inpatient unit.

Objective: To compare the experiences and preferences of pediatric hospitalists and surgeons about the content and timing of post-operative patient handoff to the acute care inpatient unit.

Design/Methods: This is a cross-sectional multisite survey of pediatric hospitalists and surgeons at 4 hospitals in Southern California using a novel survey tool. Our validation process included expert content review, cognitive interviews, and pilot testing. We included attendings, fellows, advanced practice providers, and surgery residents who were assigned inpatient clinical duties at their respective sites. The survey was distributed electronically to 115 hospitalists and 109 surgeons and was open for 8 weeks. We collected data on the perceived frequency of communication for 37 handoff elements and how essential each element was for an ideal handoff. For each element, we used 5-point Likert scales of communication frequency and essentialness, with 4 denoting very essential and 5 denoting extremely essential. Participants also identified perceived and preferred handoff timing. Descriptive statistics were calculated. Mann Whitney U Test was used to compare hospitalist and surgeon Likert responses.

Results: 70 hospitalists (61%) and 27 surgeons (25%) responded to the survey. Regarding handoff element essentialness, among all respondents for all elements, the mean rating was 4.07 ± 0.52, with a range of 2.51 to 4.91. 11 elements were rated a mean of 4.5 or greater by either hospitalists or surgeons, or by both (Table 1). Surgeons perceived that 33 handoff elements were mentioned significantly more frequently than perceived by hospitalists (p < 0.05). 55% of hospitalists preferred handoff take place immediately prior to the patient leaving the PACU compared to 28% of surgeons. In contrast, 60% of surgeons preferred handoff take place immediately post-operatively compared to 37% of hospitalists. Surgeons were more likely to have been in practice longer and participate in post-operative handoff less frequently than hospitalists. Conclusion(s): We identified 11 clinical elements that pediatric hospitalists and surgeons rate as most essential to include in handoff. These findings can facilitate development of a standardized handoff tool for post-operative communication between surgeons and hospitalists on acute care units, which may decrease communication errors and improve patient outcomes.
Stephen Overcash CVCV SFO KSOM Nov 2021.pdf