1. Meliones, Jon MD, MS
  2. Mericle, Jane BSN, MHS-CL
  3. Norman, Sharon MSN, RN, CNS, CCRN

Article Content


Decrease variability in the handoff process for postoperative pediatric cardiothoracic patients between the OR and PICU. Enhance communication between the OR and PICU team.



Patient handoffs from one team to another is a process vulnerable to errors. A commonly cited system failure involves communication errors during the handoff process.



The lack of information, teamwork, and inconsistency during handoffs for pediatric cardiothoracic patients returning from the OR had been previously identified.



Using the Six Sigma methodology and the DMAIC process (design, measure, analyze, improve, and control), a multidisciplinary team was formed. This team consisted of PICU nurses, physicians, RTs, anesthesiologists, and cardiothoracic surgeons. The team defined critical information/processes that were to occur during the handoff process. An audit tool that documented the critical information occurring during the handoff was created. Direct observation of 22 patient handoffs was done using this audit tool. Data analysis was performed and presented to the team, after which performance improvements were made including prioritization of events on arrival to the PICU. Once the team was educated on the improvements, further audits were done by direct observation on another 129 pediatric cardiothoracic patients admitted to the PICU from the operating room.



There were 22 patients in the initial group and 129 in the postintervention group. There was a significant reduction in turnaround time (15.3 to 9.9 minutes; P < .001) and laboratory draw time (13 to 2.6 minutes; P < .001. There was also an improvement in CXRs done within our standard (60% vs 94%; P < .01) and on percent of patients on the bedside cardiorespiratory monitor within our standard (86% vs 99%; P < .01).



The handoff between the OR and PICU represents a vulnerable time. Development of a standardized handoff process reduces variability, enhances teamwork, and improves patient safety.


Implications for Practice:

To utilize Six sigma and the DMAIC methodology in evaluating the handoff process for other surgical services being admitted to the PICU as well as PICU patients transferred to other acute care units.