Transfer of Care for Cardiac Surgical Patients from Cardiac OR to Pediatric Intensive Care Unit: Provincial Health Services Authority

The BC Children’s Hospital is an agency of the Provincial Health Services Authority and provides expert care for the province’s most seriously ill or injured children, including newborns and adolescents. Based in Vancouver, the hospital provides all British Columbians with vital health services. They also provide specialized training in pediatric health care and work with renowned researchers to achieve better health for children and youth.

Prior to this initiative, there were delays in transferring a patient from the cardiac operating room (Cardiac OR) to the pediatric intensive care unit (PICU) as beds were not always ready. Both the surgical team and PICU staff were unclear about their role in transferring and accepting the patient. When the patient would arrive in the PICU, often the bedside area and setup was in disarray, and staff were focused on care provision rather than giving their full attention to the handover report.

In order to determine if a difference would be made through the handover reporting process, the team applied processes called imPROVE, similar to the LEAN approach, to see exactly what the staff were doing and how they were doing it. The team found that they were experiencing unexplained delays in physically moving the patient from the Cardiac OR to the PICU. The room in the PICU unit was not always set up properly to receive the patient which caused more delays in untangling cords and double checking equipment. Another major problem was trying to get all staff involved with the patient (doctors, nurses, specialists, and other critical staff) into the same room at the same time to ensure a complete and accurate handover report was created. Staff was not always clear on which roles they were responsible for and who should be present at the transfer from the Cardiac OR to the PICU.

Once data was collected and analyzed, the team was able to have a better understanding and appreciation for members on the “other” team. Roles and responsibilities were clarified and the characteristics of a safe patient handover (Cardiac OR to PICU) were identified. Standard work such as bedside set-up, visual appearance of area, handover checklist, and an inter-professional handover protocol was defined, created and tested to identify changes. In addition, the team was able to break through historical frustrations between the Cardiac OR and the PICU.

The following changes were developed to achieve these outcomes:

• Determination of best practice for post-operative transfer of care;
• Identification and implementation of standardized processes;
• Creation of support tools to assist staff with orientation to and ongoing reference of standardized processes;
• Elimination of redundancy; and
• Clarification/definition of roles and responsibilities for all team members.

These same measures were taken four and eight weeks later to determine if the changes were sustained. All the new processes and procedures were followed perfectly, aside from one incident where an extra staff member was present in the room during the patient handover. The successful changes have freed up time for patient care and ensuring the safety of the children being transferred from the operating room to the intensive care ward.

With the implementation of this process for cardiac patients, other surgical specialties are now interested in applying the same standards. A plan for disseminating and auditing these standards of care/process has now been developed to spread this information to other surgical teams.

For more information, please contact Judy Komori (Director of Quality, Safety and Accreditation, BC Children’s Hospital and Sunny Hill Health Centre for Children) at jkomori@cw.bc.ca.