Making handover safer for trauma patients admitted to the neuro trauma icu st. michael's hospital
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The document describes a quality improvement project to develop and implement a handover checklist to standardize communication between the Trauma Team Leader and neuro-trauma ICU team when transferring trauma patients. Feedback indicated the checklist reduced information omissions. Metrics showed increased checklist use and no suggested changes after implementation, demonstrating improved handovers and patient safety.
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Making handover safer for trauma patients admitted to the neuro trauma icu st. michael's hospital
- 1. Making Handover Safer for Trauma Patients Admitted to the Neuro-Trauma ICU US Manickavasagam1 A Pronovost2,3 N Ahmed4,5 D MacKinnon6,7 A Young8 Department of Critical Care Medicine, St. Michael’s Hospital Department of Anesthesia, St. Michael’s Hospital 3 Department of Anesthesia, University of Toronto 4 Trauma Program, Department of Surgery, St. Michael’s Hospital 5 Department of Surgery, University of Toronto 6 Emergency Medicine, St. Michael’s Hospital 7 Department of Family and Community Medicine, University of Toronto 4 Quality & Risk Management, St. Michael’s Hospital 1 2 Funding for this project has been provided through the St. Michael’s Hospital Quality Improvement Fund.
- 2. ED-TTL-TNICU Handover Checklist Context • Urban, academic, level-1 trauma centre (~650 trauma team activations 2012) • A collaborative Emergency Medicine-Trauma-Critical Care model of care encourages comprehensive handover among all members of the team Problem and Issue • The potential for errors in communication is high • 50% information loss between Trauma Team Leader (TTL) and TNICU MD was identified through a 1-year retrospective review • Will a handover checklist standardize practice and reduce the omission of important information during handover of trauma patients to the TNICU? Lead Process Indicators • By April 30, 2013 100% of trauma patients transferred to the TNICU will be audited to assess the adoption of the new TTL handover checklist Metrics: • Number of patients transferred to TNICU/ Number of times the checklist used • Feedback from audits will be communicated to TTL, TNICU MD, ED RN and TNICU RN via e-mail bi-weekly until April 30, 2013 starting March 1, 2013
- 3. ED-TTL-TNICU Handover Checklist Lag Process Indicators • By April 30 2013, the number of suggestions to the TTL handover checklist will be reduced to zero Metrics: i. Number of suggestions provided by TTL, TNICU MD, ED RN and TNICU RN ii. Suggestions will be communicated to the team working on this project to further revise the current process Measurement Feedback from Users •“I think its value will be greatest when it's used by those in more junior stages of their careers as they often haven't developed the systematic means to sign off patients to others” (TTL) •“Sometimes patients were not accompanied by the TTLs” (TNICU MD) •“One time handover involving all the 4 team member saves lots of time” (ED RN) Lag Process Indicators • Zero suggestions made to content of checklist • Communication to the team is ongoing
- 4. ED-TTL-TNICU Handover Checklist Contribution to Patient Safety & Quality Improvement Trauma Team Leader Checklist for TNICU Handover Confirm All MD and RN team members have introduced themselves by name and role Patient Name Details of the Trauma Details of the Transfer Current Status Allergies, Medications and known PMH Airway/Breathing Circulation Neurological Intubation details Temperature C/T/L spine status Difficult airway: Y/N Tubes and Lines GCS Score Pneumo / Hemothorax Hypotensive episodes? Pupils A/V Blood Gas Need for transfusion? Massive Transfusion Protocol: Y/N Tranexamic Acid: Y/N • Standardizing handover will reduce mortality and information loss that will impact patient care and missed injuries • Plans are underway to permanently incorporate handover checklist into TTL charting notes and TINCU MD admission note • TTL compliance with the checklist has been added as a reportable metric to the SMH trauma score card Summary of Injuries & PlanPre -TNICU Diagnostics and Labs Medications Chest x-ray Pain meds: Y/N Pelvis x-ray Anxiolytics: Y/N FAST results Paralytics: Y/N Preliminary CT results Tetanus: Y/N Blood work: Hb / base deficit / tox screen / other Antibiotics: Y/N C-Spine T&L Spine Head Neck Thorax Abdomen Pelvis Extremities Ongoing metabolic resuscitation Next steps Family notification: Are they en-route and how can they be reached? Are police involved? Ask group: Are there any concerns? Ask TNICU MD and RN: Need for Major Torso Trauma Resuscitation Protocol?