Patient handover from surgery to intensive care: Using formula 1 pit-stop and aviation models to improve safety and quality

Paediatric Anaesthesia

Volumn 17, Issue 5, 2007, Pages 470-478

  Catchpole, Ken R ^a   De Leval, Marc R ^b   Mcewan, Angus ^b   Pigott, Nick ^b   Elliott, Martin J ^b   Mcquillan, Annette ^b   Macdonald, Carol ^b   Goldman, Allan J ^b  

^a UNIVERSITY OF OXFORD   (United Kingdom)

^b GREAT ORMOND STREET HOSPITAL   (United Kingdom)

Author keywords

Communication; Error; Handover; Quality; Safety; Teamwork

Indexed keywords

ANALYTICAL ERROR; ARTICLE; AVIATION; CHECKLIST; CLINICAL PROTOCOL; CONFIDENCE INTERVAL; HEALTH CARE QUALITY; INTENSIVE CARE; INTERVENTION STUDY; PATIENT SAFETY; PERFORMANCE; PRIORITY JOURNAL; PROSPECTIVE STUDY; REGRESSION ANALYSIS; TEAMWORK;

ADOLESCENT; AVIATION; CARDIAC SURGICAL PROCEDURES; CHILD; CHILD, PRESCHOOL; CONTINUITY OF PATIENT CARE; HEART DEFECTS, CONGENITAL; HUMANS; INFANT; INFANT, NEWBORN; INTENSIVE CARE UNITS, PEDIATRIC; INTERDISCIPLINARY COMMUNICATION; MEDICAL ERRORS; MODELS, ORGANIZATIONAL; PATIENT CARE MANAGEMENT; PATIENT CARE TEAM; PATIENT TRANSFER; PILOT PROJECTS; PROSPECTIVE STUDIES; TIME FACTORS; TOTAL QUALITY MANAGEMENT;

EID: 34247370984     PISSN: 11555645     EISSN: 14609592     Source Type: Journal    
DOI: 10.1111/j.1460-9592.2006.02239.x     Document Type: Article

References (18)

1. de Leval MR, Carthey J, Wright DJ et al. Human factors and cardiac surgery: a multicenter study. J Thorac Cardiovasc Surg 2000 119 : 661 672.
2. Woods D, Patterson E. How unexpected events produce an escalation of cognitive and coordinative demands. In : Hancock PA, Desmond PA, eds. Stress Workload and Fatigue. Hillsdale, NJ : Lawrence Erlbaum, 2004 : 290 304.
3. Fletcher GCL, McGeorge P, Flin RH et al. The role of non-technical skills in anaesthesia: a review of current literature. Br J Anaesth 2002 88 : 418 429.
4. Morey JC, Simon R, Jay GD et al. Error reduction and performance improvement in the emergency department through formal teamwork training: evaluation results of the MedTeams project. Health Serv Res 2002 37 : 1553 1581.
5. Jenkins KJ, Gauvreau K, Newburger JW et al. Consensus-based method for risk adjustment for surgery for congenital heart disease. J Thorac Cardiovasc Surg 2002 123 : 110 118.
6. Catchpole K, Godden PJ, Giddings AEB et al. Identifying and reducing errors in the operating theatre. PS012. Patient Safety Research Programme. 2005. http://pcpoh.bham.ac.uk/publichealth/psrp/Publication_PS012.htm accessed on 20 November 2006 J. Managing the Risks of Organisational Accidents. Aldershot : Ashgate, 1997.
7. Catchpole KR, Giddings AE, de Leval MR et al. Identification of systems failures in successful paediatric cardiac surgery. Ergonomics 2006 49 : 567 588.
8. Hofer TP, Hayward RA. Are bad outcomes from questionable clinical decisions preventable medical errors? A case of cascade iatrogenesis. Ann Intern Med 2002 137 : 327 333.
9. Woolf SH, Kuzel AJ, Dovey SM et al. A string of mistakes: the importance of cascade analysis in describing, counting, and preventing medical errors. Ann Fam Med 2004 2 : 317 326.
10. Jones GJ, Vanderpump MP, Easton M et al. Achieving compliance with the European Working Time Directive in a large teaching hospital: a strategic approach. Clin Med 2004 4 : 427 430.
11. Chan LS, Schonfeld N. How much information is lost during processing? A case study of pediatric emergency department records. Comput Biomed Res 1993 26 : 582 591.
12. Kluger MT, Bullock MF. Recovery room incidents: a review of 419 reports from the Anaesthetic Incident Monitoring Study (AIMS). Anaesthesia 2002 57 : 1060 1066.
13. Kostopoulou O, Shepherd A. Fragmentation of treatment and the potential for human error in neonatal intensive care. Top Health Inf Manage 2000 20 : 78 92.
14. Horn J, Bell MD, Moss E. Handover of responsibility for the anaesthetised patient - opinion and practice. Anaesthesia 2004 59 : 658 663.
15. O'Connell B, Penney W. Challenging the handover ritual. Recommendations for research and practice. Collegian 2001 8 : 14 18.
16. Pothier D, Monteiro P, Mooktiar M et al. Pilot study to show the loss of important data in nursing handover. Br J Nurs 2005 14 : 1090 1093.
17. Castledine G. The importance of a good shift handover of patients. Br J Nurs 2006 15 : 524.
18. Carthey J. The role of structured observational research in health care. Qual Saf Health Care 2003 12 : 13ii 16ii.