Cardiac surgical care: The characteristics of intraoperative handoffs

Introduction: Handoffs are a source of potential harm to the safety of patients since the process of transferring information and equipment increases the likelihood for error. Human factors research has found that a lack of protocols, formal guidance and procedural training are associated with inconsistencies in the handoff process and can cause coordination problems and threaten patient safety (Cohen & Hilligoss, 2010). Much of the current literature emphasizes communication breakdowns as the foremost problem that hinders the effectiveness of handoffs (Cohen & Hilligoss, 2010). Breakdowns in communication during handoffs can lead to confusion about the patient’s condition and appropriate care, inconsistent patient monitoring, medication errors, delays in diagnosis, and lack of follow through on referral (Arora et al., 2005; Cohen & Hilligoss, 2010; Greenberg, 2007; Mistry et al., 2008). Therefore, vulnerabilities or threats to patient safety result from the reality that errors or omissions in the information promulgated during the handoff often become a “fact” for the next person or team using the information (Philibert & Leach, 2005). However, much of the published literature on handoffs has focused primarily on preoperative and postoperative handoffs (Arora et al., 2009; Cohen & Hilligoss, 2010; Dracup et al., 2008). Very little is known about intraoperative handoffs and their impacts on the surgical team during cardiac surgery. Intraoperative handoffs are defined as the exchange of surgical staff members in which one person transfers control over, or responsibility for, the performance of specific tasks associated with the surgical care of a patient and then subsequently departs the operating room (OR) for any given period of time (Christian et al., 2006; Cohen & Hilligoss, 2010). A recent incident report of a kidney transplant surgery misfortune highlights the importance of research in intraoperative handoffs (Feehan, 2012). In this particular incident, a nurse unknowingly deposed of a healthy donor’s kidney after an intraoperative handoff occurred during the transplant procedure. This catastrophe was due to the omission of pertinent or no information being relayed during the intraoperative handoff process. Comprehensive intraoperative handoff studies are, therefore, essential to understanding intraoperative handoffs intrinsic ability to impact health care processes and outcomes. Therefore, the present study prospectively examined the characteristics of intraoperative handoffs and their impacts on the surgical team during cardiac surgery.