OR-to-ICU Handoffs

[N2b8]

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I'm gearing up to start my senior project, which is studying more effective ways to hand off patients from the OR to ICU. There is nothing formal where I'm training, and some places it's done by the circulator, not anesthesia. Do any of you have formal procedures for doing this? Please let me know -- I appreciate your time in advance!

 

[rsgillmd]

I'm gearing up to start my senior project, which is studying more effective ways to hand off patients from the OR to ICU. There is nothing formal where I'm training, and some places it's done by the circulator, not anesthesia. Do any of you have formal procedures for doing this? Please let me know -- I appreciate your time in advance!

Nothing formal at my institution in practice. Officially all hand-offs should follow the SBAR format (situation background, I can't remember the rest). I tried reading through some examples they gave in that format, and it was more confusing.

My main thing is to talk directly to the resident who is going to be taking care of the patient, not just to the nurse. My general format is: Pt. X is a Y year old male just s/p z procedure for [diagnosis]. His past medical history is significant for....His past surgical history is significant for....Allergies....Relevant social history (ex: daily alcohol use, etc.) if any...Height and Weight...IV access...Invasive Lines...Intubation related information (any difficulty, if intubated tube is taped at d cm, etc.)...Relevant meds given (including antibiotics) and when...Any issues during the case...Fluids in...EBL...U/O...Last Hct/Glucose/Electrolyte values if relevant....Any requests by surgeon for post-op care (ex. keep BP <150 mmHg)...Any questions before I leave?

I don't think the order or specific content matters so much as the fact that the resident/attending who will be taking over the post-op care feels I have answered their questions. In my institution the SICU attending may not always be present, but there is always a resident present. If the SICU attending is around, he makes sure to come in the room when a new patient arrives. I make sure I sign out to the resident before I leave, because I remember how overwhelming it was sometimes (because I had so many other patients to take care of also) to receive a new patient and have to go through the whole chart myself as opposed to talking to a human being who can summarize the important stuff.