Improving Communication Between ICU Nurses and Anesthesia Providers Using a Standardized Handoff Protocol

Published:October 11, 2022DOI:



      This quality improvement (QI) project aimed to improve handoff communication between intensive care unit (ICU) nurses and anesthesia providers using a standardized preoperative handoff protocol for nonemergent and noncardiac procedures.


      A quality improvement project.


      Following project approval, the project team provided staff education regarding a pre-populated handoff tool from the electronic medical record (EMR) adapted for perioperative use. In addition, the project team assessed the providers’ perception and satisfaction with handoff communication before and after the intervention.


      Of the 128 transfers, 76% completed the handoff tool during the 1-month implementation phase. CRNAs (n = 60), Registered Nurses (RNs; n = 88), and anesthesia residents (n = 30) completed the pre-and post-implementation surveys. Pre-implementation, 40% of providers were dissatisfied with communication, and only 14% reported dissatisfaction post-implementation. Also, 40% of providers believed this handoff protocol increased the amount of accurate information shared during reports without delaying the transition of care.


      The standardized handoff tool appears to improve information sharing during the transfer of care and improve provider satisfaction with the handoff process. Long term, it may reduce adverse patient events and improve outcomes. Use of a pre-populated handoff tool from the EMR provides a cost-effective solution to decrease erroneous reporting by removing human error associated with the recall.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of PeriAnesthesia Nursing
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Shah AC
        • Oh DC
        • Xue AH
        • et al.
        An electronic handoff tool to facilitate transfer of care from anesthesia to nursing in intensive care units.
        J Health Inform. 2019; 25: 3-16
        • Krimminger D
        • Sona C
        • Thomas-Horton E
        • et al.
        A multidisciplinary QI initiative to improve OR-ICU handovers.
        Am J Nurs. 2018; 118: 48-59
        • Karamchandani K
        • Fitzgerald K
        • Carroll D
        • et al.
        A multidisciplinary handoff process to standardize the transfer of care between the intensive care unit and the operating room.
        Qual Manag Health Care. 2018; 27: 215-222
        • Inadequate handoff communication
        Sentinel Event Alert.
        2017: 1-6
        • Halladay M
        • Thompson J
        • Vacchiano C.
        Enhancing the quality of the anesthesia to postanesthesia care unit patient transfer through use of an electronic medical record–based handoff tool.
        J PeriAnes Nurs. 2019; 34: 622-632
        • McElroy L
        • Macapagal K
        • Collins K
        • Abecassis
        • et al.
        Clinician perceptions of operating room to intensive care unit handoffs and implications for patient safety: A qualitative study.
        Am J Surg. 2015; 210: 629-635
        • Lane-Fall MB
        • Pascual JL
        • Massa S
        • et al.
        Developing a standard handoff process for operating room-to-ICU transitions: Multidisciplinary clinician perspectives from the handoffs and transitions in critical care (HATRICC) study.
        Jt Comm J Qual Patient Saf. 2018; 44: 514-525
        • Lewin K.C.
        Field Theory in Social Science.
        Harper & Row, New York, NY1951
        • Moon TS
        • Gonzales MX
        • Wood AP
        • et al.
        Improving the quality of the operating room to intensive care unit handover at an urban teaching hospital through a bundled intervention.
        J Clin Anesth. 2016; 31: 5-12