gms | German Medical Science

18. Deutscher Kongress für Versorgungsforschung

Deutsches Netzwerk Versorgungsforschung e. V.

09. - 11.10.2019, Berlin

Teamwork during postsurgical handovers and associated effects for provider outcomes: A multi-source and observational study in paediatric care

Meeting Abstract

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  • Matthias Weigl - Klinikum der Universität München (LMU), Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin, München, Germany
  • Julia Keil - Kinderklinik und Kinderpoliklinik im Dr. von Haunerschen Kinderspital, Interdisziplinäre Kinderintensivstation, München, Germany
  • Florian Hoffmann - Kinderklinik und Kinderpoliklinik im Dr. von Haunerschen Kinderspital, Interdisziplinäre Kinderintensivstation, München, Germany

18. Deutscher Kongress für Versorgungsforschung (DKVF). Berlin, 09.-11.10.2019. Düsseldorf: German Medical Science GMS Publishing House; 2019. Doc19dkvf085

doi: 10.3205/19dkvf085, urn:nbn:de:0183-19dkvf0859

Veröffentlicht: 2. Oktober 2019

© 2019 Weigl et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.


Gliederung

Text

Background: Effective transmission of patient information is fundamental to quality and safety of patient care. Postsurgical handover of paediatric patients from operating rooms to intensive care units is a critical moment. This process is susceptible to errors and inefficiencies particularly if poor teamwork in this multi-disciplinary and ad-hoc collaboration occurs. To the best of our knowledge, multi-method assessments that contrast expert evaluations and provider self-assessments are missing. Particularly in the context of actual post-operative patient transfers in naturalistic hospital care settings and care delivery processes.

Objective: Through concurrently combining provider- and observer-rated team performance, we aimed to determine agreement levels on team performance and associations with mental demands, disruptions, and stress.

Method: An observational and multi-source study of provider and concomitant expert-observer ratings was established. In an Academic Paediatric Hospital, we conducted standardized observations of postsurgical handovers to PICU. We applied established observational and self-reported teamwork tools. Nested fixed- and mixed-models were established to estimate agreement within teams, between providers’ and observer’s ratings, as well as for estimations between team performance and mental demands, disruptions, and stress outcomes.

Results: 31 postsurgical patient handovers were included with overall 109 ratings of involved providers. Provider-perceived team performance was rated high. Within the receiving sub-team, situation awareness was perceived lower compared to the handoff sub-team [F(df=1)=4.41, p=.04]. Inter-provider agreement on handover team performance was low for the overall team, yet higher within handover sub-teams. We observed that high level of distractions during the handover was associated with inferior team performance rated by observers (B=-.72, 95% CI: -1.44, -.01).

Discussion: Efficient teamwork and comprehensive transfer of patient information across disciplines and clinical area is essential for safe and reliable patient handovers. We observed significant differences and disagreements on how the transfer was perceived by the involved professionals. Our findings advocate further that handovers should be performed under low levels of distractions. Future studies should carefully consider if provider and/or observer assessments without prior training and development of shared understandings are a feasible and reliable way to evaluate teamwork in paediatric care.

Implications: Our findings corroborate that a common handover language should be established and mandatory before jointly evaluating this process. Moreover, our findings call for further health services research and tool development in the domain of intra-hospital patient transfers to establish consistent observational and self-report measures that facilitate application in naturalistic hospital care environments.