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Anesth Analg. 2015 Oct;121(4):957-71. doi: 10.1213/ANE.0000000000000670.

A Multimodal Intervention Improves Postanesthesia Care Unit Handovers.

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From the *Center for Research and Innovation in Systems Safety (CRISS), Institute for Medicine and Public Health, Vanderbilt University, Nashville, Tennessee; †Health Services Research Division and the Geriatrics Research Education and Clinical Center, Veterans Affairs (VA) Tennessee Valley Healthcare System, Nashville Campus, Nashville, Tennessee; ‡Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, Tennessee; §Center for Experiential Learning and Assessment, Department of Medical Education, Vanderbilt University School of Medicine, Nashville, Tennessee; ‖Perioperative Nursing and Nurse Education, Vanderbilt University Medical Center, Nashville, Tennessee; ¶Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee; #Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, Tennessee; **School of Nursing, Vanderbilt University, Nashville, Tennessee; ††Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee; and ‡‡Health Information Management and Systems Division, School of Health and Rehabilitation Sciences, Ohio State University College of Medicine, Columbus, Ohio.



Failures of communication are a major contributor to perioperative adverse events. Transitions of care may be particularly vulnerable. We sought to improve postoperative handovers.


We introduced a multimodal intervention in an adult and a pediatric postanesthesia care unit (PACU) to improve postoperative handovers between anesthesia providers (APs) and PACU registered nurses (RNs). The intervention included a standardized electronic handover report form, a didactic webinar, mandatory simulation training focused on improving interprofessional communication, and post-training performance feedback. Trained, blinded nurse observers scored PACU handovers during 17 months using a structured tool consisting of 8 subscales and a global score (1-5 scale). Multivariate logistic regression assessed the effect of the intervention on the proportion of observed handovers receiving a global effectiveness rating of ≥3.


Four hundred fifty-two clinicians received the simulation-based training, and 981 handovers were observed and rated. In the adult PACU, the estimated percentages of acceptable handovers (global ratings ≥3) among AP-RN pairs, where neither received simulation-based training (untrained dyads), was 3% (95% confidence interval, 1%-11%) at day 0, 10% (5%-19%) at training initiation (day 40), and 57% (33%-78%) at 1-year post-training initiation (day 405). For AP-RN pairs where at least one received the simulation-based training (trained dyads), these percentages were estimated to be 18% (11%-28%) and 68% (57%-76%) on days 40 and 405, respectively. The percentage of acceptable handovers was significantly greater on day 405 than it was on day 40 for both untrained (P < 0.001) and trained dyads (P < 0.001). Similar patterns were observed in the pediatric PACU. Three years later, the unadjusted estimate of the probability of an acceptable handover was 87% (72%-95%) in the adult PACU and 56% (40%-72%) in the pediatric PACU.


A multimodal intervention substantially improved interprofessional PACU handovers, including those by clinicians who had not undergone formal simulation training. An effect appeared to be present >3 years later.

[Indexed for MEDLINE]

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