Checklist Improves Communication During Patient Transfers

A recent prospective study found that a standardized checklist and transfer protocol can reduce errors during transfer of care for post-operative pediatric surgical airway patients (Otolaryngol Head Neck Surg. 2012;146(1):129-34).

Monica Kleinman, MD, clinical director of the medical/surgical intensive care unit at Children’s Hospital Boston, said the checklist can be adapted for numerous types of surgical or interventional procedures. “Communication is the root of all evil and the secret of success, particularly in medicine, and I think everyone can relate to the fact that most problems can be, at least in part, traced back to a communication issue,” she said.

Researchers from the department of otolaryngology at the Massachusetts Eye and Ear Infirmary (MEEI) decided to study the issue after two pediatric airway patients at their institution experienced post-operative airway emergencies because the multidisciplinary teams providing their post-surgical care were unfamiliar with the surgery that each patient had undergone.

The otolaryngologists responded by forming a multi-specialty focus group comprising an attending physician, a fellow, a resident from MEEI, a pediatric resident, a hospitalist, a pediatric intensive care unit fellow and an attending from Massachusetts General Hospital. The group conducted a literature review, led and moderated by the senior otolaryngology attending, and carried out a root cause analysis that identified two main areas of concern within the hand-off period: geographical provider separation and multiple providers at various training levels working in shifts.

The result was the development of a one-page document, accessible via electronic medical record, containing essential information for all team members to review during patient handoffs, including status post, medication, diet, tracheotomy needs, airway emergency procedures, contact information for the care team and further transfer protocol. According to the study authors, the checklist is to be used in a proactive team huddle during the transfer process, in which all providers meet to summarize their understanding of the patient’s needs.

Subsequent analyses of follow-up data of 93 pediatric airway patients at one month and 11 months found no adverse events related to miscommunication during pediatric airway patient transfer. Informal surveys were given to the various members of the multidisciplinary care team, who said the checklist not only reduced errors but also made the transfer process more efficient.

Dr. Kleinman, whose division recently implemented a similar checklist for patient handoffs, said that a team huddle is the best communication method and that the addition of a checklist is a way to make sure critical pieces of information are not “left to the chance of someone remembering to include them.”