A Longitudinal and Sustainability Assessment of Pediatric Interfacility Transport Handover Standardization

Anthony A Sochet; Kelsey S Ryan; Walter Miller; Jennifer L Bartlett; Thomas A Nakagawa; Ladonna Bingham

doi:10.1097/pq9.0000000000000118

A Longitudinal and Sustainability Assessment of Pediatric Interfacility Transport Handover Standardization

Pediatr Qual Saf. 2018 Nov 8;3(6):e118. doi: 10.1097/pq9.0000000000000118. eCollection 2018 Nov-Dec.

Authors

Anthony A Sochet¹, Kelsey S Ryan², Walter Miller³, Jennifer L Bartlett¹, Thomas A Nakagawa¹, Ladonna Bingham^{1

3}

Affiliations

¹ Department of Medicine, Division of Pediatric Critical Care Medicine, Johns Hopkins University, Johns Hopkins All Children's Hospital, St. Petersburg, Fla.
² Department of Pediatrics, Pediatric Residency, University of South Florida College of Medicine, Tampa, Fla.
³ Department of Medicine, Division of Pediatric Transport Medicine, Johns Hopkins University, Johns Hopkins All Children's Hospital, St. Petersburg, Fla.

Abstract

Introduction: Standardization of interfacility transport handover is associated with improved shared mental model development, efficiency, and teaming. We sought to build upon previously published data by evaluating 1-year follow-up data, assessing face-validity, and describing sustainability.

Methods: We performed a pre-post, retrospective cohort study in a stand-alone, tertiary, pediatric referral center for children 0-18 years of age transported to our pediatric intensive care unit, neonatal intensive care unit, or emergency department from October 2016 to November 2017. Handover was standardized using multidisciplinary checklists, didactics, and simulation. Data were collected for three 8-week periods (preintervention, postintervention, and 1-year follow-up). Outcomes included shared mental model index (shared mental model congruence expressed as an index, percent congruence regarding healthcare data), teaming data (efficiency, attendance, interruptions, interdependence), and face validity (5-point, Likert scale questionnaires). Statistics included 1-way analysis of variance, Kruskal-Wallis, chi-square, and descriptive statistics.

Results: One hundred forty-eight handovers (50 preintervention, 50 postintervention, and 48 at 1-year) were observed in the emergency department (41%), pediatric intensive care unit (45%), and neonatal intensive care unit (14%). No differences were noted in demographics, diagnoses, PIM-3-ROM, length of stay, mortality, ventilation, or vasoactive use. Sustained improvements were observed in shared mental model congruence expressed as an index (38% to 82%), physician attendance (76% to 92%), punctuality (91.5% to 97.5%), interruptions (40% to 10%), provision of anticipatory guidance (42% to 85%), and handover summarization (42% to 85%, all P < 0.01). Efficiency was maintained throughout (mean duration 4.5 ± 2.1 minutes). Face validity data revealed handover satisfaction, effective communication, and perceived professionalism.

Conclusions: Enhancements in teaming, shared mental model development, and face validity were achieved and sustained 1-year following handover standardization with only minimal reeducation during the study period.