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Background: The Operating Room (OR) to Pediatric Intensive Care Unit (PICU) handoff at University of Iowa Hospital and Clinics was unstructured and inefficient with poor interdepartmental relations and communication. Aim: Streamline the OR-to-PICU handoff process using the performance improvement principles of LEAN. Hypothesis: A multidisciplinary project aimed at improving the OR-to-PICU handoff will result in improved efficiency, team dynamics and communication. Method: The current handoff process was observed and recorded. Based on observations and staff survey results, a lean structured handoff process was designed which included a checklist. This proposed handoff was simulated, piloted and implemented after modifications. The new handoff was observed and recorded for comparison. The staff survey was repeated at 6, 12 and 24 months to assess satisfaction and solicit feedback. Compliance with the structured handoff process was verified by auditing the checklist completed during handoff. Improvement in communication and interdepartmental relations was assessed via the survey questions and Patient Safety Net (PSN) reports. Results: The structured handoff process needed fewer personnel and less time. Survey results suggested that communication, efficiency and interdepartmental relations were better with the new hand off process and results were consistent at 6, 12 and 24 months. Average compliance with the structured handoff was 64% at 6 months, 56% at 12 months and 52% at 24 months, while the average compliance on day, night and weekend shifts was 50%, 40% and 38% respectively. The number of PSN reports related to communication or professionalism decreased with the structured hand off process. Conclusion: Multidisciplinary projects are a helpful way to drive process improvement while improving team dynamics and interdepartmental relations. The success of our project has resulted in the adoption of structured handoff for postoperative patients in critical care units across the institution.

Operating Room to Pediatric Intensive Care Unit Handoff: Improving Communication and Team Relations While Driving Process Improvement