Abstract
Objective
To compare the incidence, severity, preventability, and contributing factors of non-routine events—deviations from optimal care based on the clinical situation—associated with team-based, nurse-to-nurse, and mixed handovers in a large cohort of surgical neonates.
Study design
A prospective observational study and one-time cross-sectional provider survey were conducted at one urban academic children’s hospital. 130 non-cardiac surgical cases in 109 neonates who received pre- and post-operative NICU care.
Results
The incidence of clinician-reported NREs was high (101/130 cases, 78%) but did not differ significantly across acuity-tailored neonatal handover practices. National Surgical Quality Improvement—Pediatric occurrences of major morbidity were significantly higher (p < 0.001) in direct team handovers than indirect nursing or mixed handovers.
Conclusions
NREs occur at a high rate and are of variable severity in neonatal perioperative care. NRE rates and contributory factors were homogenous across handover types. Surveyed clinicians recommend structured handovers for all patients at every transfer point regardless of acuity.
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Acknowledgements
We greatly appreciate the informatics support Jonathan Wanderer, MD, and the Vanderbilt Anesthesiology & Perioperative Informatics Research (VAPIR) Division provided in developing an algorithm to automatically identify eligible study patients through the surgical schedule. Funding: This study was supported by funding from the National Institute of Child Health and Human Development (1R01HD086792-01).
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All of the individuals listed as authors on the title page contributed to the conception, design, and execution of the study plan, contributed to the writing and/or revision of the manuscript, and approved the final version of the manuscript. Each author has had full access to the study data and was involved the final decision to submit these data for publication.
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France, D.J., Slagle, J., Schremp, E. et al. Impact of patient handover structure on neonatal perioperative safety. J Perinatol 39, 453–467 (2019). https://doi.org/10.1038/s41372-018-0305-6
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DOI: https://doi.org/10.1038/s41372-018-0305-6
